Analysis of risk factors for death after blunt traumatic rupture of the thoracic aorta.

UNLABELLED: Traumatic aortic rupture (TAR) is a rare but serious injury, leading to death at the scene in most cases. Between 1990 and 2003, all consecutive patients and victims with TAR were retrospectively analysed by reviewing hospital and autopsy records. Univariate and multivariate Cox regression analyses were performed to define determinants of mortality. During the study period, a total of 85 patients (70 men, mean age 47±18.8 years) with TAR were observed in the greater area of Zurich giving a population-based rate of 0.6 cases per 100 000 persons per year. Prehospital, in-hospital and overall mortalities were 40.0%, 31.4% and 58.8%, respectively, with a median survival time of 2 days (IQR 1-3617 days). In the univariate analysis, significant determinants of prehospital and overall mortality were age (HR 1.05, p=0.006), complete aortic transection (HR 7.17, p=0.003), number (HR 1.35, p=0.009) and associated injuries to chest (HR 3.41, p=0.03), liver (HR 6.00, p=0.002) and spine (HR 5.19, p=0.01). By comparison, risk factors for in-hospital mortality included haemodynamic instability upon arrival in the emergency room (HR 16.11, p<0.001) and open surgical repair (HR 14.29, p=0.02). In the multivariate model, only age (p=0.02) and complete aortic transection (p=0.001) were significant determinants of mortality. Therefore, with the exception of complete aortic transection, risk factors of prehospital and in-hospital death in patients with TAR differ greatly. The in-hospital mortality was not affected by the number or localisation of associated injuries, whereas haemodynamic instability and open aortic repair seem to predict in-hospital mortality after TAR. CLINICAL TRIAL REGISTRATION: NCT01632774. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.