Outcome after blunt traumatic thoracic aortic laceration: identification of a high-risk cohort. Western Trauma Association Multicenter Study Group.

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 outcome.
METHODS: BTTAL data from 14 trauma centers over 11 years. Hospital and autopsy records of confirmed BTTAL were retrospectively reviewed. Regression analysis evaluated outcome by trauma indices, age, premorbidities, interventions, adjuvant therapy, and delay of repair.
RESULTS: Three hundred ninety-five cases of BTTAL were identified, 233 who were stable. Stable cohort survival was 71.9%. No trauma indices predicted 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. Delay of >4 hours to operative repair was not associated with increased mortality. Increasing age was associated with higher mortality. Multivariate 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 undergoing operative repair. Treating comorbidities and managing associated injuries should be undertaken in stable BTTAL patients. Physiologic stability should be established before repair of BTTAL.