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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 652-660, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RA Cowley, SZ Turney, JR Hankins, A Rodriguez, S Attar and BS Shankar
During the 15 years from 1971 through 1985, 114 patients with rupture of
the thoracic aorta caused by blunt trauma were admitted to the Shock Trauma
Center of the Maryland Institute for Emergency Medical Services Systems.
Mean age was 31.3 years (range, 15 to 80). Ninety were male and 24 were
female, a 3.75:1 ratio. Of the 114, 89 (78.1%) survived initial
resuscitation in the admitting area. Twenty five of the 89 initial
survivors (28.1%) died during or after surgical repair. Paraplegia occurred
in 11 of the 78 operating room survivors (14.1%). Further analysis was done
of the 83 patients admitted in the 10-year period from 1976 through 1985.
Mean Injury Severity Score, excluding aortic injury, was 18.2. Twenty-five
of the 83 (30.1%) died during resuscitation in the admitting area or
operating room. Seven others died during surgical repair and 12 died
postoperatively, leaving 39 survivors (39/83 [47%] of total admissions and
39/58 [67.2%] of survivors of resuscitation). Paraplegia/paresis developed
postoperatively in six of 34 (17.6%) cases involving shunt and four of 17
(23.5%) without shunt. Other major complications occurred in 21 of the
operating room survivors. Statistically significant risk of death or major
complication was associated with female sex, higher Injury Severity Score,
lower admission blood pressure, larger hemothorax on admission, less
qualified surgeon, major operation before aortic repair, use of shunt, and
transfer directly from scene of injury. There was no advantage in this
series to using or not using a shunt in preventing paraplegia. Mortality
rates are realistic for a highly developed trauma system. Better techniques
are needed to manage exsanguination and prevent paraplegia.
ARTICLES
Rupture of thoracic aorta caused by blunt trauma. A fifteen-year experience
Maryland Institute for Emergency Medical Services Systems, Baltimore.
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