Benjamin R Zambetti1, Dih-Dih Huang1, Richard H Lewis1, Peter E Fischer1, Martin A Croce1, Louis J Magnotti2. 1. Department of Surgery, Division of Trauma and Surgical Critical Care, University of Tennessee Health Science Center, Memphis, Tennessee. 2. Department of Surgery, Division of Trauma and Surgical Critical Care, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: lmagnott@uthsc.edu.
Abstract
BACKGROUND: Blunt aortic injury (BAI) and traumatic brain injury (TBI) represent the two leading causes of death following blunt trauma. The goal of this study was to examine the impact of TBI and use of thoracic endovascular aortic repair (TEVAR) on patients with BAI using a large, national dataset. STUDY DESIGN: Patients with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 10-years, ending in 2016. Patients with BAI were stratified by presence of concomitant TBI and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in BAI patients with and without TBI. Youden's index was used to identify the optimal time to TEVAR in these patients. RESULTS: 17,040 patients with BAI were identified with 4,748 (28%) having a TBI. Patients with BAI and TBI were predominantly male, with a higher injury burden and greater severity of shock at presentation, underwent fewer TEVAR procedures and had increased mortality compared to BAI patients without TBI. The optimal time for TEVAR was 9 hours. Mortality was significantly increased in patients undergoing TEVAR prior to 9 hours (12.9% vs 6.5%, p=0.003). For BAI patients with and without TBI, MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (OR 0.41; 95%CI 0.32-0.54, p<0.0001). CONCLUSIONS: TBI significantly increases mortality in BAI patients. TEVAR and delayed repair both significantly reduced mortality. Thus, for patients with both BAI and TBI, an endovascular repair performed in a delayed fashion should be the preferred approach.
BACKGROUND: Blunt aortic injury (BAI) and traumatic brain injury (TBI) represent the two leading causes of death following blunt trauma. The goal of this study was to examine the impact of TBI and use of thoracic endovascular aortic repair (TEVAR) on patients with BAI using a large, national dataset. STUDY DESIGN:Patients with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 10-years, ending in 2016. Patients with BAI were stratified by presence of concomitant TBI and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in BAI patients with and without TBI. Youden's index was used to identify the optimal time to TEVAR in these patients. RESULTS: 17,040 patients with BAI were identified with 4,748 (28%) having a TBI. Patients with BAI and TBI were predominantly male, with a higher injury burden and greater severity of shock at presentation, underwent fewer TEVAR procedures and had increased mortality compared to BAI patients without TBI. The optimal time for TEVAR was 9 hours. Mortality was significantly increased in patients undergoing TEVAR prior to 9 hours (12.9% vs 6.5%, p=0.003). For BAI patients with and without TBI, MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (OR 0.41; 95%CI 0.32-0.54, p<0.0001). CONCLUSIONS: TBI significantly increases mortality in BAI patients. TEVAR and delayed repair both significantly reduced mortality. Thus, for patients with both BAI and TBI, an endovascular repair performed in a delayed fashion should be the preferred approach.