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.
Highlights
Hemorrhage is a leading cause of preventable trauma death [1,2]
We included all deaths under the jurisdiction of the Harris County Medical Examiner, including prehospital deaths and those occurring in non-trauma centers, in addition to those occurring in trauma centers
We performed a secondary analysis of a study by Drake et al which analyzed all trauma deaths that occurred in Harris County, TX in 2014
Summary
A retrospective study by Eastridge et al, of 4596 combat casualty mortalities from 2001 to 2011 reported that 24% of deaths were potentially preventable, of which 90% were related to inadequate hemorrhage control [3]. Drake et al conducted a retrospective review of all death-related (including prehospital and hospital medical examiner) records that occurred during 2014 in Harris County, Texas and determined the preventable and potentially preventable trauma death rate to be 36% [7]. Similar to the military’s methodology, the objective of the present study was to describe the anatomic characteristics and preventability of aortic injuries in deceased civilian trauma patients to identify potential targets for intervention. 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). Optimal prehospital and ED treatment include temporizing hemorrhage control, hemostatic resuscitation, and faster transport to definitive treatment
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