Close surveillance imaging is unnecessary for patients with grade I blunt thoracic aortic injury

Sayuri P Jinadasa; Ariel L Mueller; Annie Apffel; Brandon Cave; Joseph J DuBose; Thomas M Scalea; Rishi Kundi

doi:10.1016/j.amjsurg.2022.06.007

Close surveillance imaging is unnecessary for patients with grade I blunt thoracic aortic injury

Am J Surg. 2022 Nov;224(5):1324-1328. doi: 10.1016/j.amjsurg.2022.06.007. Epub 2022 Jun 9.

Authors

Sayuri P Jinadasa¹, Ariel L Mueller², Annie Apffel³, Brandon Cave⁴, Joseph J DuBose⁵, Thomas M Scalea⁶, Rishi Kundi⁷

Affiliations

¹ R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA. Electronic address: [email protected].
² Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: [email protected].
³ University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD, 21201, USA. Electronic address: [email protected].
⁴ University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD, 21201, USA. Electronic address: [email protected].
⁵ R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA. Electronic address: [email protected].
⁶ R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA. Electronic address: [email protected].
⁷ R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA. Electronic address: [email protected].

PMID: 35728986
DOI: 10.1016/j.amjsurg.2022.06.007

Abstract

Background: No evidence-based recommendations exist for imaging surveillance of grade I blunt thoracic aortic injuries (BTAI). We aimed to evaluate the natural history of these injuries to provide guidance for follow-up imaging.

Methods: Patients that presented to our trauma center from 2008 to 2021 with grade I BTAI were retrospectively evaluated. CT angiography images were assessed for initial injury grade and subsequent stability, improvement, worsening, or resolution.

Results: Of 83 patients who had grade I injuries and repeat imaging, 57.8% had complete resolution, 20.5% had improvement, and 18.1% had stability of their injury. Only seven patients (8.4%) demonstrated worsening of their injury. Six patients had eventual resolution and one underwent endovascular repair that would not have been performed under current practice patterns.

Conclusions: Since grade I injuries do not worsen to require later surgical intervention, early surveillance imaging is not necessary and further imaging may not be necessary at all.

Keywords: Blunt thoracic aortic injury; CT angiography; Surveillance imaging.

MeSH terms

Aorta, Thoracic / diagnostic imaging
Aorta, Thoracic / injuries
Aorta, Thoracic / surgery
Endovascular Procedures* / methods
Humans
Injury Severity Score
Retrospective Studies
Thoracic Injuries* / diagnostic imaging
Thoracic Injuries* / surgery
Time Factors
Treatment Outcome
Vascular System Injuries* / diagnostic imaging
Vascular System Injuries* / surgery
Wounds, Nonpenetrating* / diagnostic imaging
Wounds, Nonpenetrating* / surgery