AORTIC TRANSECTION

Background: Traumatic aortic transection is uncommon in those trauma p atients reaching hospital alive. Methods: The Victorian Major Trauma S tudy (VMTS) received data from 25 hospitals in Victoria, a State of 4. 4 million people, and identified 1874 patients with blunt trauma and I njury Severity Score (ISS) greater than 15 over a 2-year period (1 Mar ch 1992-28 February 1993 and 1 May 1994-30 April 1995). The Federal Of fice of Road Safety (FORS) examined coronial data from 1 January 1992 to 31 December 1992. These studies allowed a retrospective, population -based review of experience with aortic transection. Results: The VMTS identified 19 patients who reached hospital, with signs of life at th e scene of the accident, during a 2-year period. Of these, 8 left hosp ital alive: 4 without disability and 4 with disability related to non- thoracic injury. The annual incidence of aortic transection for the St ate, based on FORS data, was 13 per 1 000 000, lower than other report ed studies. Review of the management of patients in hospital confirmed the usefulness of initial chest X-ray in diagnosis and the high incid ence of associated injury. Conclusions: The study raises a number of i ssues, including the question of direct referral of patients with seve re chest injury to hospitals with cardiothoracic facilities, increased use of transoesophageal echocardiography in diagnosis and increased u se of immediate laparotomy and thoracotomy in certain patients.