Aortic transection

Traumatic aortic transection is uncommon in those trauma patients reaching hospital alive.

The Victorian Major Trauma Study (VMTS) received data from 25 hospitals in Victoria, a State of 4.4 million people, and identified 1874 patients with blunt trauma and Injury Severity Score (ISS) greater than 15 over a 2-year period (1 March 1992-28 February 1993 and 1 May 1994-30 April 1995). The Federal Office of Road Safety (FORS) examined coronial data from 1 January 1992 to 31 December 1992. These studies allowed a retrospective, population-based review of experience with aortic transection.

The VMTS identified 19 patients who reached hospital, with signs of life at the scene of the accident, during a 2-year period. Of these, 8 left hospital alive: 4 without disability and 4 with disability related to non-thoracic injury. The annual incidence of aortic transection for the State, based on FORS data, was 13 per 1000000, lower than other reported studies. Review of the management of patients in hospital confirmed the usefulness of initial chest X-ray in diagnosis and the high incidence of associated injury.

The study raises a number of issues, including the question of direct referral of patients with severe chest injury to hospitals with cardiothoracic facilities, increased use of transoesophageal echocardiography in diagnosis and increased use of immediate laparotomy and thoracotomy in certain patients.