NONCORRELATION BETWEEN THORACIC SKELETAL INJURIES AND ACUTE TRAUMATICAORTIC TEAR

It is generally accepted that the presence of thoracic skeletal injuri es has a predictive value for acute traumatic aortic tear (ATAT). The purpose of this study is to objectively assess the validity of that pr emise. The initial chest radiographs of 548 patients who underwent aor tic angiography for suspected ATAT were reviewed for thoracic skeletal injuries, The incidence of thoracic skeletal injuries was compared be tween patients with and without angiographically confirmed ATAT. Rib f racture is the only thoracic skeletal injury whose incidence is statis tically significantly higher in patients with ATAT (36 of 62, 58.1%) t han in those without (207 of 486, 42.6%) (p = 0.0209), The positive pr edictive value of rib fractures in evaluating ATAT, however, is 14.8%, a rate similar to the incidence of ATAT at most trauma centers, and t he specificity is 57.4%, The second most common finding in patients wi th ATAT, the absence of thoracic skeletal injury, is not statistically :significantly different between patients with ATAT (24 of 62, 38.7%) and those without (220 of 486, 45.3%) (p = 0.3279). We conclude that ( 1) there is no clinically relevant correlation between thoracic skelet al injuries and ATAT, and (2) selection of patients requiring thoracic aortography must be based on appropriate mechanism of injury and radi ographic evidence of mediastinal hematoma.