Aortic injuries in crush trauma patients: different mechanism, different management

Autor: José M. Lopez-Perez, Milagros Marini, Javier Muñiz, Víctor Mosquera, J.J Cuenca, Daniel Gulías
Rok vydání: 2011
Předmět:
Adult
Male
medicine.medical_specialty
Databases
Factual
Poison control
Aorta
Thoracic
Wounds
Nonpenetrating
Risk Assessment
Rhabdomyolysis
Injury Severity Score
Risk Factors
medicine.artery
Injury prevention
medicine
Thoracic aorta
Humans
Hospital Mortality
Crush syndrome
Creatine Kinase
Aorta
General Environmental Science
Aged
Retrospective Studies
integumentary system
Endovascular
business.industry
musculoskeletal
neural
and ocular physiology
Acute kidney injury
Retrospective cohort study
Acute Kidney Injury
Length of Stay
Middle Aged
medicine.disease
Survival Analysis
Surgery
body regions
surgical procedures
operative
Early Diagnosis
Treatment Outcome
nervous system
Cardiothoracic surgery
General Earth and Planetary Sciences
Emergency medicine
Crush Syndrome
business
Follow-Up Studies
Glomerular Filtration Rate
Zdroj: RUC. Repositorio da Universidade da Coruña
instname
RUNA. Repositorio da Consellería de Sanidade e Sergas
Servizo Galego de Saúde (SERGAS)
ISSN: 1879-0267
Popis: [Abstract] Background. The objective of this study is to report the clinical and radiological characteristics and early and long-term survival of a series of acute traumatic aortic injuries (ATAI) in crush trauma patients, and to compare such data with our last 30 years experience managing ATAI in deceleration non-crush trauma patients. Methods. From January 1980 to December 2010, 5 consecutive ATAI in crush trauma and 69 in non-crush trauma patients were admitted at our institution. ISS, RTS and TRISS scores were similar in both groups. Results. Overall in-hospital mortality was 24.3%. There was no in-hospital mortality in crush patients and 26.1% in non-crush patients (p = 0.32). All aortic-related complications occurred in non-crush patients. Median follow-up was 129 months (range 3–350 months). Non-crush group survival was 76.8% at 1 year, 73.6% at 5 years, and 71.2%% at 10 years. There was no mortality during follow-up in the crush group. Mean (SD) peak creatine phosphokinase was significantly higher in crush group than in non-crush group: 7598 (3690) IU/L vs. 3645 (2506) IU/L; p = 0.041. Incidence of acute renal injury was higher in crush trauma patients (100% vs. 36.2%; p = 0.018). Low-severity injuries were more common in crush trauma patients (100% in crush patients vs. 43.5% in non-crush patients, p = 0.04). Conclusions. Aortic injuries in crush thoracic trauma patients seem to present in a different clinical scenario from aortic injuries in high-speed thoracic trauma thus requiring distinct considerations. When planning the initial management of aortic injuries in crush trauma, the increased risk of rhabdomiolysis and subsequent acute renal failure, as well as a tendency to develop lower-risk aortic wall injuries, must be considered.
Databáze: OpenAIRE
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