Blunt Thoracic Aortic Injury in the Geriatric Population: Results from the Aortic Trauma Foundation

The management of blunt thoracic aortic injury (BTAI) is evolving as the trauma population ages, yet the impact of age on treatment patterns and outcomes remains incompletely defined.

A retrospective analysis of the Aortic Trauma Foundation registry (November 2016-November 2023) identified 823 patients with BTAI, including 118 geriatric patients (≥65 years). Demographics, injury characteristics, management strategies, and outcomes were compared between geriatric and younger (<65 years) cohorts.

Geriatric patients more frequently presented after falls (17.8% vs 6.7%, p<0.0001) and had a higher proportion of grade IV injuries (18.5% vs 9.2%, p=0.0021), with no difference in admission systolic blood pressure (116 vs 116, p=0.960) or Injury Severity Score (31 vs 33, p=0.150). Management strategies were similar between groups, including nonoperative (37.3% vs 36.9%, p=0.932), open (4.2% vs 1.9%, p=0.132), and endovascular repair (58.5% vs 61.1%, p=0.584). Despite comparable treatment approaches, geriatric patients had higher in-hospital mortality (27.1% vs 10.9%, p<0.0001) and aortic-related mortality (8.5% vs 3.4%, p=0.010).

Geriatric patients with BTAI sustain more severe injuries and experience significantly higher mortality despite similar management strategies. These findings suggest that current treatment paradigms may not adequately address age-associated risk and highlight the need for age-specific management considerations.