A worldwide systematic review of blunt abdominal aortic injury and analysis of predictors for death

Abstract

Background Blunt abdominal aortic injury (BAAI) is characterized by diverse clinical manifestations, evaluations, and treatment criteria, while very high mortality. At present, there are few studies on BAAI, and most of them are case reports. Methods By including available case reports world widely, a systematic review regarding the data of BAAI patients in characteristics, treatments, and outcomes was performed. And regression analysis of predictors for death after BAAI was conducted. Results The systematic search of Excerpta Medica Database, PubMed, Web of Science and Cochrane Library resulted in 2,099 hits. There were 102 case reports and 1 conference abstract met the inclusion criteria and were eligible for analysis. After assessment using the Joanna Briggs Institute (JBI) checklist, no low-quality studies were found. Then the data of 133 BAAI patients were concluded and analyzed. The median age of these patients was 34, and there were 98 (73.7%) males. Their most common clinical manifestation was pain (65.6%). The most common severity of aortic lesion was grade A (intimal tear or intramural hematoma) (46.9%), and the most common location of aortic lesion was zone III (infrarenal aorta) (88.3%). The overall mortality after BAAI was 15.3%. On multivariable regression analysis, the risk of death after BAAI was increased in patients with lower limb ischemia [relative risk (RR), 7.137; 95% confidence interval (CI), 1.154–44.161], cardiopulmonary arrest (RR, 10.250; 95% CI, 1.452–72.344), and injuries to other parts (other than abdomen and lumbar spine) of body (RR, 2.593; 95% CI, 1.189–5.655). Then on subgroup analysis, patients with BAAI in the presence of lower limb ischemia or injuries to other parts of body, whether undergoing primary or secondary operation, had lower mortality than those who underwent conservative observation (P < 0.05), but the mortality of BAAI patients who presented with cardiopulmonary arrest would not be affected by different treatment modalities (P = 1.000). Conclusions BAAI is a fatal disease. The above three variables are risk factors for death after BAAI. Operation (in any form) to BAAI patients who have these risk factors may reduce their mortality risks.