Blunt Aortic Injury – Does Pan-scan Help?

Written by Clay Smith

Spoon Feed
Blunt traumatic aortic injury is extremely rare and often has associated chest injuries. High-energy mechanism + wide mediastinum had poor sensitivity. The NEXUS Chest CT rule was 100% sensitive.

Why does this matter?
Major injury prevalence has remained constant, while CT use for trauma has doubled. Often, the rationale for scanning the chest is to avoid missing aortic injury. Are all these CT scans helping patients?

Can we reduce chest scans?
This was a pre-planned analysis of NEXUS Chest, with 24,010 patients. Of these, 0.17% (just 42 patients) had aortic injury. Of patients with aortic injury, 79% had associated thoracic injury, such as rib fractures, pneumothorax, hemothorax or pulmonary contusion. In fact, isolated aortic injury occurred in only 0.03% (9/24,010). No patients died of their aortic injuries, rather from brain injury. Over half had surgery, all endovascular repair. Patients with aortic injury on CT had similar mortality but longer length of stay. The classic way to screen for aortic injury – high-energy mechanism* + widened mediastinum on CXR – had just 76% sensitivity. However, the NEXUS Chest CT rule was 100% sensitive.

*High-energy mechanism = fall > 20 feet, MVC > 40 miles per hour, or pedestrian struck by motorized vehicle

Source
Blunt Traumatic Aortic Injury in the Pan-scan Era. Acad Emerg Med. 2019 Dec 7. doi: 10.1111/acem.13900. [Epub ahead of print]

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