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Do patients with blunt thoracic aortic injury present to hospital with unstable vital signs? A systematic review and meta-analysis
  1. Jordan Bade-Boon1,2,
  2. Joseph K Mathew1,2,3,
  3. Mark C Fitzgerald1,2,3,
  4. Biswadev Mitra1,2,4
  1. 1 Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
  2. 2 National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
  3. 3 Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
  4. 4 Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Jordan Bade-Boon, National Trauma Research Institute, Melbourne, VIC 3004, Australia; jordan.badeboon{at}gmail.com

Abstract

Background Blunt thoracic aortic injury (BTAI) is an uncommon diagnosis, usually developing as a consequence of high-impact acceleration–deceleration mechanisms. Timely diagnosis may enable early resuscitation and reduction of shear forces, essential to prevent worsening of the injury prior to definitive management. Death is commonly due to haemorrhagic shock, but clinical features may be absent until sudden and massive haemorrhage.

Objectives The aim of this systematic review was to determine the proportion of patients with BTAI who present with unstable vital signs.

Methods Manuscripts were identified through a search of MEDLINE, EMBASE and the Cochrane Library databases, focusing on subject headings and keywords related to the aorta and trauma. Mechanisms of injury, haemodynamic status and mortality from the included manuscripts were reviewed. Meta-analysis of presenting haemodynamic status among a select group of similar papers was conducted.

Results Nineteen studies were included, with five selected for meta-analysis. Most reported cases of BTAI (80.0%–100%) were caused by road traffic incidents, with mortality consistently higher among initially unstable patients. There was statistically significant heterogeneity among the included studies (P<0.01). The pooled proportion of patients with haemodynamic instability in the setting of BTAI was 48.8% (95% CI 8.3 to 89.4).

Conclusions Normal vital signs do not rule out aortic injury. A high degree of clinical suspicion and liberal use of imaging is necessary to prevent missed or delayed diagnoses.

  • aorta
  • wounds and injuries
  • blunt
  • aortic rupture
  • aortic aneurysm
  • hypotension

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Footnotes

  • Contributors All authors have made substantial contributions to the design of the study, drafting and revising the article, and final approval of the manuscript and its submission to the journal. Specifically, JB-B, BM and MCF planned the study; JB-B, JKM and BM designed the search strategy; JB-B and BM undertook the study selection process; JB-B undertook the data extraction process; JB-B, BM and MCF undertook the data analysis; BM provided statistical review; JB-B, JKM and BM articulated the discussion section; JB-B, JKM, MCF and BM revised the manuscript; JB-B submitted the study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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