Background: In the era of frequent head-through-pelvis CT scan for adult blunt trauma patient evaluation, we sought to update teachings regarding aortic/great vessel (A/GV) injury using the largest, prospectively derived database of adult blunt trauma chest injuries (the NEXUS Chest study database). Specifically, we sought to 1) define the incidence of A/GV injury in adult blunt trauma patients; 2) determine the prevalence of thoracic injuries associated with A/GV injury; 3) determine how often patients with A/GV injury have widened mediastinum and other traumatic abnormalities seen on chest x-rays (CXRs); and 4) determine whether NEXUS Chest clinical decision rule (CDR) criteria detected all A/GV injuries.
Methods: We conducted this pre-planned analysis of patients prospectively enrolled in the NEXUS Chest studies at eleven Level 1 US trauma centers with the following inclusion criteria: age > 14 years, blunt trauma within 12 hours of ED presentation, and receiving chest imaging during ED trauma evaluation. A/GV (and other) injuries were defined according to CT reports. We followed subjects through their hospital course to determine clinical outcomes.
Results: Of 24,010 enrolled subjects, 42 (0.2%) had A/GV injury. Their median age was 49 years; 76% were male; median Injury Severity Score was 29, and the most common mechanisms of injury were motor vehicle collision (55%), pedestrian struck by motor vehicle (19%), and motorcycle accident (14%). Most patients (57%) had surgical interventions (primarily endovascular repair) and 38 (90% [95% CI 78-96%]) survived to hospital discharge. 33 patients (79% [95% CI 64-88%]) had an associated thoracic injury, most commonly rib fractures (57%), pneumothorax (45%), pulmonary contusion (31%), hemothorax (24%), and sternal fracture (12%). The sensitivity (Sn) for A/GV injury of widened mediastinum on CXR was 54.8% (95% CI 40-69%); Sn of either widened mediastinum or other traumatic injury on CXR was 97.6% (95% CI 88-100%); and Sn of the NEXUS Chest CDRs was 100% (95% CI 92-100%).
Conclusion: We found that A/GV injury is uncommon. After arrival to the ED, most patients with A/GV injury survived to hospital discharge. Most patients with (A/GV) injury had other thoracic injuries. Widened mediastinum on CXR is not an adequate screen for (A/GV) injury, but NEXUS Chest criteria detected all (A/GV) injuries.