Characteristics of Trauma Mortality in Patients with Aortic Injury in Harris County, Texas

• Type of Material: Article
• Authors: Ronald Chang, Emory University; Stacy A. Drake, Texas A&M University; John B. Holcomb, University of Alabama; Garrett Phillips, Harris County Institute of Forensic Sciences; Charles E. Wade, University of Texas Houston; Kristofer M. Charlton-Ouw, HCA Houston Healthcare
• Language: English
• Date: 2020-09-14
• Publisher: MDPI AG
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/jcm9092965
• Title of Journal or Parent Work: Journal of Clinical Medicine
• Volume: 9
• Issue: 9
• Grant/Funding Information: The study was in part funded from two internal UTHealth sources: UTHealth Cizik School of Nursing PARTNERS Grant and Center for Translational Injury Research (CeTIR). No external funding was utilized for this manuscript.
• Keywords: trauma; non-compressible torso hemorrhage; aortic injury
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: The National Academies of Science have issued a call for zero preventable trauma deaths. The mortality characteristics in all patients with aortic injury are not well described. Methods: All prehospital and hospital medical examiner records for deaths occurring in Harris County, Texas in 2014 were retrospectively reviewed, and patients with traumatic aortic injury were selected. The level of aortic injury was categorized by zone (0 through 9) and further grouped by aortic region (arch, zones 0 to 2; descending thoracic, zones 3 to 5; visceral abdominal, zones 6 to 8; infrarenal, zone 9). Multiple investigators used standardized criteria to categorize deaths as preventable, potentially preventable, or non-preventable. Results: Of 1848 trauma deaths, 192 (10%) had aortic injury. There were 59 (31%) aortic arch, 144 (75%) descending thoracic, 19 (10%) visceral abdominal, and 20 (10%) infrarenal aortic injuries. There were 178 (93%) non-preventable deaths and 14 (7%) potentially preventable deaths, and none were preventable. Non-preventable deaths were associated with blunt trauma (69%) and the arch or thoracic aorta (93%), whereas potentially preventable deaths were associated with penetrating trauma (93%) and the visceral abdominal or infrarenal aorta (79%) (all p < 0.05). Half of potentially preventable deaths (n = 7) occurred at the scene, and half occurred at a trauma center. Conclusion: Potentially preventable deaths after aortic injury were associated with penetrating mechanism and injury to the visceral abdominal and/or infrarenal aorta. Optimal prehospital and ED treatment include temporizing hemorrhage control, hemostatic resuscitation, and faster transport to definitive treatment.