| Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma. | |
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MedLine Citation:
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PMID: 9095103 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. METHODS: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma. RESULTS: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = 30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. CONCLUSIONS: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach. |
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Authors:
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T C Fabian; J D Richardson; M A Croce; J S Smith; G Rodman; P A Kearney; W Flynn; A L Ney; J B Cone; F A Luchette; D H Wisner; D J Scholten; B L Beaver; A K Conn; R Coscia; D B Hoyt; J A Morris; J D Harviel; A B Peitzman; R P Bynoe; D L Diamond; M Wall; J D Gates; J A Asensio; B L Enderson |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study |
Journal Detail:
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Title: The Journal of trauma Volume: 42 ISSN: 0022-5282 ISO Abbreviation: J Trauma Publication Date: 1997 Mar |
Date Detail:
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Created Date: 1997-05-01 Completed Date: 1997-05-01 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 374-80; discussion 380-3 Citation Subset: AIM; IM |
Affiliation:
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University of Tennessee, Memphis, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Aorta, Thoracic / injuries*, surgery Child Diagnostic Imaging Female Humans Male Middle Aged Paraplegia / etiology Postoperative Complications Prospective Studies Treatment Outcome Vascular Surgical Procedures / methods Wounds, Nonpenetrating / diagnosis, mortality, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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