OUTCOME AFTER BLUNT TRAUMATIC THORACIC AORTIC LACERATION - IDENTIFICATION OF A HIGH-RISK COHORT

Background: Specific cohorts of patients with blunt traumatic thoracic aortic laceration (BTTAL) might benefit from conservative or delayed management. We hypothesized that age and comorbidities would predict o utcome. Methods: BTTAL data from 14 trauma centers over 11 years. Hosp ital and autopsy records of confirmed BTTAL were retrospectively revie wed. Regression analysis evaluated outcome by trauma indices, age, pre morbidities, interventions, adjuvant therapy, and delay of repair. Res ults: Three hundred ninety-five cases of BTTAL were identified, 233 wh o were stable. Stable cohort survival was 71.9%. No trauma indices pre dicted outcome. Comorbidities, especially coronary artery disease (CAD ), were associated with mortality. The use of beta-blocking agents and maintenance of normal blood pressure were associated with survival. D elay of >4 hours to operative repair was not associated with increased mortality. Increasing age was associated with higher mortality. Multi variate regression found CAD and AGE predictive of mortality (log odds formula: exp [-2.0858 + 0.0253(AGE) + 2.0428(CAD)]). Conclusions: AGE and CAD are associated with worse outcome in stable BTTAL patients un dergoing operative repair. Treating comorbidities and managing associa ted injuries should be undertaken in stable BTTAL patients. Physiologi c stability should be established before repair of BTTAL.