Predictors of Discharge Home after Blunt Traumatic Thoracic Aortic Injury

El-Beheiry, Mostafa; Kidane, Biniam; Zehr, Meaghan; Vogt, Kelly; Parry, Neil; Malthaner, Richard; Forbes, Thomas L.

doi:10.1016/j.avsg.2015.07.019

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…Previous studies have emphasized the impact of an initial high ISS on BTAI grade and potential survival. 23,26 Moreover, thoracic aortic stent grafts are not always available off the shelf in our centers.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Early versus Delayed Endovascular Repair of Blunt Traumatic Aortic Injuries

Shamsi¹,

Naiem²,

Abdelhadi³

et al. 2019

Oman Med J

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Objectives Thoracic endovascular aortic repair (TEVAR) has surpassed open surgical repair in the management of blunt traumatic aortic injuries (BTAIs) over the past two decades. It is a less morbid procedure associated with lower mortality. We sought to determine the outcomes of early versus delayed TEVAR of BTAI in our population. Methods We conducted a retrospective analysis of a prospectively collected registry that looked at patients presenting with an image-proven diagnosis of BTAI at three tertiary health care facilities in Muscat, Oman. Forty consecutive patients were identified between January 2012 and July 2017, of which four were excluded for incomplete data. The remaining 36 patients were divided based on the timing of repair into early (< 7 days) or delayed ( 3 7 days) repair. In both cohorts, variables analyzed included patient demographics, mechanism of injury, injury severity score, need for blood products transfusion, use of anti-impulse medications, anticoagulation, intensive care unit (ICU) stay, and total hospital stay. Primary endpoints included: in-hospital mortality, TEVAR-related morbidity, and the need for reintervention. Results Our study subjects were young with a mean age of 33.5±14.8 and 29.9±11.0 years in the early and delayed repair cohorts, respectively. Motor vehicle collisions accounted for the majority of cases (82.6% and 76.9% in early and delayed repair, respectively). Thoracic injuries were the most commonly associated injuries in both early and delayed repair cohorts. Compared to early repair, the delayed repair cohort had a higher incidence of exploratory laparotomies, but the difference was not statistically significant ( p = 0.161). There were four incidences of cerebrovascular accidents (CVAs) post-TEVAR; three in the early repair cohort and one in the delayed repair cohort ( p = 1.000). There was no statistically significant correlation between left subclavian total or partial coverage and the incidence of CVA ( p = 0.220) and type 1 ( p = 0.466) or type 2 endoleak ( p = 0.102). The early repair cohort had a longer but not statistically significant ICU stay (7.8±6.8 vs. 5.3±10.7, p = 0.386). Prolonged ICU stay was associated with more blood transfusion requirement ( p < 0.001), and higher respiratory ( p = 0.010) and gastrointestinal complications ( p = 0.026). Conclusions The short-term outcomes for TEVAR of BTAI continue to show its feasibility in managing BTAI in severely injured patients. There was no clear statistical significance in mortality and morbidity comparing early versus delayed repair. However, our experience is based on a small sample size and short median follow-up but provides a good p...

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Section: Discussionmentioning

confidence: 99%

Outcomes of Early versus Delayed Endovascular Repair of Blunt Traumatic Aortic Injuries

Shamsi¹,

Naiem²,

Abdelhadi³

et al. 2019

Oman Med J

View full text Add to dashboard Cite

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“…Despite such potential benefits of early discharge planning in trauma patients, limited work has been done in predicting the discharge disposition among such patients. 12-17 Existing studies focus on specific traumatic conditions and rely on single institution or state data, which limits the generalizability of the developed models. Other studies have examined specific issues affecting discharge disposition (ie, racial disparities).…”

Section: Introductionmentioning

confidence: 99%

Predicting Discharge Disposition in Trauma Patients: Development, Validation, and Generalization of a Model Using the National Trauma Data Bank

Graham

Parikh

Hirpara

et al. 2020

The American Surgeon

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Background Limited work has been done in predicting discharge disposition in trauma patients; most studies use single institutional data and have limited generalizability. This study develops and validates a model to predict, at admission, trauma patients’ discharge disposition using NTDB, transforms the model into an easy-to-use score, and subsequently evaluates its generalizability on institutional data. Methods NTDB data were used to build and validate a binary logistic regression model using derivation-validation (ie, train-test) approach to predict patient disposition location (home vs non-home) upon admission. The model was then converted into a trauma disposition score (TDS) using an optimization-based approach. The generalizability of TDS was evaluated on institutional data from a single Level I trauma center in the U.S. Results A total of 614 625 patients in the NTDB were included in the study; 212 684 (34.6%) went to a non-home location. Patients with a non-home disposition compared to home had significantly higher age (69 ± 19.7 vs 48.3 ± 20.3) and ISS (11.2 ± 8.2 vs 8.2 ± 6.3); P < .001. Older age, female sex, higher ISS, comorbidities (cancer, cardiovascular, coagulopathy, diabetes, hepatic, neurological, psychiatric, renal, substance abuse), and Medicare insurance were independent predictors of non-home discharge. The logistic regression model’s AUC was 0.8; TDS achieved a correlation of 0.99 and performed similarly well on institutional data (n = 3161); AUC = 0.8. Conclusion We developed a score based on a large national trauma database that has acceptable performance on local institutions to predict patient discharge disposition at the time of admission. TDS can aid in early discharge preparation for likely-to-be non-home patients and may improve hospital efficiency.

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Predictors of discharge destination in patients with major traumatic injury: Analysis of Oklahoma Trauma Registry

Khorgami

Ewing

Mushtaq

et al. 2019

The American Journal of Surgery

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Predictors of Discharge Home after Blunt Traumatic Thoracic Aortic Injury

Cited by 5 publications

References 15 publications

Outcomes of Early versus Delayed Endovascular Repair of Blunt Traumatic Aortic Injuries

Outcomes of Early versus Delayed Endovascular Repair of Blunt Traumatic Aortic Injuries

Predicting Discharge Disposition in Trauma Patients: Development, Validation, and Generalization of a Model Using the National Trauma Data Bank

Predictors of discharge destination in patients with major traumatic injury: Analysis of Oklahoma Trauma Registry

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