Use of Thoracic Endovascular Aortic Repair in Patients with Concomitant Blunt Aortic and Traumatic Brain Injury.
J Am Coll Surg
; 232(4): 416-422, 2021 04.
Article
en En
| MEDLINE
| ID: mdl-33348014
ABSTRACT
BACKGROUND:
Blunt aortic injury (BAI) and traumatic brain injury (TBI) represent the 2 leading causes of death after blunt trauma. The goal of this study was to examine the impact of TBI and use of thoracic endovascular aortic repair (TEVAR) on patients with BAI, using a large, national dataset. STUDYDESIGN:
Patients with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 10 years, ending in 2016. Patients with BAI were stratified by the presence of concomitant TBI and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in BAI patients with and without TBI. Youden's index was used to identify the optimal time to TEVAR in these patients.RESULTS:
17,040 patients with BAI were identified, with 4,748 (28%) having a TBI. Patients with BAI and TBI were predominantly male, with a higher injury burden and greater severity of shock at presentation, underwent fewer TEVAR procedures, and had increased mortality compared with BAI patients without TBI. The optimal time for TEVAR was 9 hours. Mortality was significantly increased in patients undergoing TEVAR before 9 hours (12.9% vs 6.5%, p = 0.003). For BAI patients with and without TBI, MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (odds ratio [OR] 0.41; 95%CI 0.32-0.54, p < 0.0001).CONCLUSIONS:
TBI significantly increases mortality in BAI patients. TEVAR and delayed repair both significantly reduced mortality. So, for patients with both BAI and TBI, an endovascular repair performed in a delayed fashion should be the preferred approach.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Heridas no Penetrantes
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Traumatismo Múltiple
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Lesiones del Sistema Vascular
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Procedimientos Endovasculares
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Lesiones Traumáticas del Encéfalo
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
/
Guideline
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Idioma:
En
Revista:
J Am Coll Surg
Asunto de la revista:
GINECOLOGIA
/
OBSTETRICIA
Año:
2021
Tipo del documento:
Article
País de afiliación:
Túnez