A single-center experience on the management of pediatric blunt aortic injury

Kim, Soo-Yeon; Modrall, J. Gregory; Malekpour, Fatemeh; Siah, Michael; Ramanan, Bala; Tsai, Shirling; Timaran, Carlos H.; Kirkwood, Melissa L.

doi:10.1016/j.jvs.2021.12.067

Cited by 6 publications

(10 citation statements)

References 12 publications

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“…After running the Metaprop command (metaprop event n, random ftt) in Stata 16, the results showed a high degree of heterogeneity ( I 2 = 78.8%, P = 0.001 for Q test). One study [ 27 ], which reported only 16 cases of BAAI and had a mortality rate of 0%, was removed due to potential severe heterogeneity. The remaining four studies reported OHMs ranging from 28.0 to 38.9%, and the random effects model indicates that the pooled ES was 30.1% (95% CI 26.3–33.9%, I 2 = 47.6%, P = 0.126 for Q test).…”

Section: Resultsmentioning

confidence: 99%

“…In addition, the five included studies were all from the USA. Except for the excluded article that exclusively included juveniles and had a sample size of only 16 [ 27 ], 2 of the remaining 4 exclusively included adults [ 4 , 30 ]. These factors may reduce the fitting effect of the results of the present study for populations overall.…”

Section: Discussionmentioning

confidence: 99%

“…It is worth noting that the study [ 30 ] that explored predictors of death in BAAI did not include the location and grade of aortic lesions, which are two important variables. Shalhub et al [ 1 ] reported that the AA is divided into three zones [zone I, above the superior mesenteric artery (SMA); zone II, from the SMA to renal artery; and zone III, infrarenal] to guide the operation for BAAI, which is a widely recognized method [ 27 – 29 , 39 , 40 ]. Although this study was excluded from the present meta-analysis of OHM because its data were completely duplicated with one [ 28 ] of the included studies, it reported mortality rates of BAAI by aortic lesion location, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…In combination with the opinions of Shalhub et al [ 1 ], we consider that the reason for the significantly lower mortality in zone III is that compared to those in the other two zones, the aortic injuries in this zone are less complicated with the injuries of other organs or aortic branches, and they are easier to expose by open surgery or to repair endovascularly. Of note, all the locations of aortic lesions in patients in the excluded study [ 27 ] were zone III, whereas the other two available studies reported the proportion of this lesion location to be 66.4% [ 28 ] and 68.8% [ 29 ], respectively. Although the pooled analysis was not completed due to high heterogeneity to obtain a specific value, we found that zone III injuries accounted for the majority, providing some confidence to clinicians and patients.…”

Section: Discussionmentioning

confidence: 99%

“…In the excluded study [ 27 ], the mechanisms of injury for all patients were all seat belt-related motor vehicle accidents. Although the rate of seat belt-related mechanisms could not be extracted directly from the three included studies [ 4 , 28 , 30 ] that reported relevant data due to nonuniformity in classification standards and missing data, the rate is expected to greatly differ from 100%.…”

Section: Discussionmentioning

confidence: 99%

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Hospital mortality of blunt abdominal aortic injury (BAAI): a systematic review and meta-analysis

Yan

Wang

et al. 2023

World J Emerg Surg

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Background Studies on the mortality of blunt abdominal aortic injury (BAAI) are rare and have yielded inconsistent results. In the present study, we aimed to quantitatively analyse the retrieved data to more accurately determine the hospital mortality of BAAI. Methods The Excerpta Medica Database, PubMed, Web of Science and Cochrane Library databases were searched to identify relevant publications without date restrictions. The overall hospital mortality (OHM) of BAAI patients was set as the primary outcome measure. English publications with data that met the selection criteria were included. The quality of all included studies was assessed by the Joanna Briggs Institute checklist and the American Agency for Health Care Quality and Research’s cross-sectional study quality evaluation items. After data extraction, a meta-analysis of the Freeman–Tukey double arcsine transformation of data was performed using the Metaprop command in Stata 16 software. Heterogeneity was assessed and reported as a percentage using the I2 index value and as a P value using the Cochrane Q test. Various methods were used to determine the sources of heterogeneity and to analyse the sensitivity of the computation model. Results Of the 2147 references screened, 5 studies that involved 1593 patients met the selection criteria and were included. There were no low-quality references after assessment. One study that only included 16 juvenile BAAI patients was excluded from the meta-analysis of the primary outcome measure due to high heterogeneity. Due to the low heterogeneity (I2 = 47.6%, P = 0.126 for Q test) that was observed after using the random effects model, the fixed model was subsequently used to pool the effect sizes of the remaining four studies, thus yielding an OHM of 28.8% [95% confidence interval (CI) 26.5–31.1%]. The stability of the model was verified by sensitivity analysis, and Egger’s test (P = 0.339) indicated a low level of publication bias. In addition, we also performed meta-analyses and obtained a pooled hospital mortality of operation (13.5%, 95% CI 8.0–20.0%), a pooled hospital mortality of non-operation (28.4%, 95% CI 25.9–31.0%), and a pooled rate of aortic rupture (12.2%, 95% CI 7.0–18.5%) of BAAI. Conclusions The present study indicated that BAAI has an OHM of 28.8%, indicating that this disease deserves more attention and research.

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Section: Resultsmentioning

confidence: 99%