Mortality and prognostic factors in penetrating injuries of the aorta

This study was designed to investigate the epidemiology and prognostic factors determining survival in penetrating injuries of the aorta.

This was a retrospective analysis of all patients with penetrating aortic injuries, admitted to a large, level I trauma center. The following factors were analyzed for their role in determining survival: mechanism of injury, anatomical site of the aortic injury, initial blood pressure on admission, need for emergency room thoracotomy, and the introduction of a dedicated trauma program with an attending surgeon in-house.

There were 93 patients with penetrating aortic injuries over a 5-year period. The abdominal aorta was injured in 67 patients (72%) and the thoracic aorta in 26 (28%). Most of the victims (82.5%) were admitted in shock and 41% had an unrecordable blood pressure on admission. Victims with injury to the thoracic aorta were more likely to have an unrecordable blood pressure on admission than patients with abdominal aortic injuries (73% vs 28.4%), and more likely to require an emergency room thoracotomy (76.9% vs 20.9%). Thirty-four patients (36.6%) required an emergency room thoracotomy and there were no survivors. The overall mortality was 80.6% (87.5% for gunshot injuries, 64.7 % for knife injuries). Patients with abdominal aortic injuries were three times more likely to survive than those with thoracic aortic injuries (23.9% vs 7.7%). The introduction of a dedicated trauma program, which resulted in significant reduction of mortality in other types of severe trauma, had no effect on the outcome in aortic injuries.

Penetrating aortic injuries still have a very high mortality rate with no improvement in survival despite improved trauma services. Injury to the thoracic aorta, gunshot wounds, unrecordable blood pressure on admission, and the need for emergency room thoracotomy, are important predictors of high mortality.