The Evolution of Care Improves Outcome in Blunt Thoracic Aortic Injury: A Western Trauma Association Multicenter Study.

Background: The management of blunt thoracic aortic injury (BTAI) has evolved radically in the last decade with changes in the processes of care and the introduction of thoracic endovascular repair (TEVAR). These changes have wrought improved outcome, but the direct effect of TEVAR on outcome remains in question as previous studies have lacked vigorous risk adjustment and long-term follow-up. To address these knowledge gaps, we compared the outcomes of TEVAR, open surgical repair, and nonoperative management for BTAI. Methods: Eight verified trauma centers recruited from the Western Trauma Association Multicenter Study Group retrospectively studied all patients with BTAI admitted between 1/1/2006 and 6/30/2016. Data included demographics, comorbidities, admitting physiology, injury severity, in-hospital care, and outcome. Results: We studied 316 patients with BTAI; 57 (18.0%) were in extremis and died before treatment. Of the 259 treated surgically, TEVAR was performed in 176 (68.0%), open in 28 (10.8%), hybrid in 4 (1.5%), and nonoperative in 51 (19.7%). TEVAR and open repair groups had similar ISS, chest AIS, TRISS and probability of survival, but differed in median age (open: 28 [interquartile range {IQR}: 19-51]; TEVAR: 46 [IQR: 28-60], p

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