Evaluation and management of blunt traumatic aortic injury: A practice management guideline from the Eastern Association for the Surgery of Trauma

Nicole Fox, Diane Alyse Schwartz, Jose H. Salazar, Elliott R. Haut, Philipp Dahm, James H. Black, Scott C. Brakenridge, John J. Como, Kimberly Hendershot, David R. King, Adrian A. Maung, Matthew L. Moorman, Kimberly Nagy, Laura B. Petrey, Ronald Tesoriero, Thomas M. Scalea, Timothy C. Fabian

Research output: Contribution to journalArticle

Abstract

Background: Blunt traumatic aortic injury (BTAI) is the second most common cause of death in trauma patients. Eighty percent of patients with BTAI will die before reaching a trauma center. The issues of how to diagnose, treat, and manage BTAI were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the practice management guidelines on this topic published in 2000. Since that time, there have been advances in the management of BTAI. As a result, the EAST guidelines committee decided to develop updated guidelines for this topic using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework recently adopted by EAST. Methods: A systematic review of the MEDLINE database using PubMed was performed. The search retrieved English language articles regarding BTAI from 1998 to 2013. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included imaging to diagnose BTAI, type of operative repair, and timing of operative repair. Results: Sixty articles were identified. Of these, 51 articles were selected to construct the guidelines. Conclusion: There have been changes in practice since the publication of the previous guidelines in 2000. Computed tomography of the chest with intravenous contrast is strongly recommended to diagnose clinically significant BTAI. Endovascular repair is strongly recommended for patients without contraindications. Delayed repair of BTAI is suggested, with the stipulation that effective blood pressure control must be used in these patients.

Original languageEnglish (US)
Pages (from-to)136-146
Number of pages11
JournalJournal of Trauma and Acute Care Surgery
Volume78
Issue number1
DOIs
StatePublished - Jan 13 2015

Keywords

  • Blunt aortic injury
  • blunt aortic trauma
  • traumatic aortic injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Fox, N., Schwartz, D. A., Salazar, J. H., Haut, E. R., Dahm, P., Black, J. H., Brakenridge, S. C., Como, J. J., Hendershot, K., King, D. R., Maung, A. A., Moorman, M. L., Nagy, K., Petrey, L. B., Tesoriero, R., Scalea, T. M., & Fabian, T. C. (2015). Evaluation and management of blunt traumatic aortic injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. Journal of Trauma and Acute Care Surgery, 78(1), 136-146. https://doi.org/10.1097/TA.0000000000000470