PROSPECTIVE-STUDY OF BLUNT AORTIC INJURY - HELICAL CT IS DIAGNOSTIC AND ANTIHYPERTENSIVE THERAPY REDUCES RUPTURE

Objective There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) f or the diagnosis of blunt aortic injury (BAI). The second was to evalu ate the efficacy of beta-blockers with or without nitroprusside in pre venting aortic rupture. Summary Background Data Aortography has been t he standard for diagnosing BAI for the past 4 decades. Conventional ch est CT has not proven to be of significant value. Helical CT scanning is faster and has higher resolution than conventional CT. Retrospectiv e studies have suggested the efficacy of antihypertensives in preventi ng aortic rupture. Methods A prospective study comparing HCTT to aorto graphy in the diagnosis of BAI was performed. A protocol of beta-block ers with or without nitroprusside was also examined for efficacy in pr eventing rupture before aortic repair and in allowing delayed repair i n patients with significant associated injuries. Results Over a period of 4 years, 494 patients were studied. BAl was diagnosed in 71 patien ts. Sensitivity was 100% for HCTT versus 92% for aortography, Specific ity was 83% for HCTT versus 99% for aortography. Accuracy was 86% for HCTT versus 97% for aortography. Positive predictive value was 50% for HCTT versus 97% for aortography, Negative predictive value was 100% f or HCTT versus 97% for aortography. No patient had spontaneous rupture in this study. Conclusions HCTT is sensitive for diagnosing intimal i njuries and pseudoaneurysms. Patients without direct HCTT evidence of BAl require no further evaluation. Aortography can be reserved for ind eterminate HCTT scans. Early diagnosis with HCTT and presumptive treat ment with the antihypertensive regimen eliminated in-hospital aortic r upture.