PC204. Contemporary Management Patterns for Blunt Thoracic Aortic Injury: Are Some Patients Being Left Behind?

To describe contemporary management patterns for patients hospitalized with blunt thoracic aortic injury (BTAI) and to identify factors associated with BTAI management strategy and in-hospital mortality after BTAI. Our study included patients from the 2011 to 2015 National Trauma Data Bank who were hospitalized after sustaining BTAI. Patients who died in the emergency department (ED) or sustained any type of nonsurvivable injury were excluded. To account for missing data, multiple imputation was performed using chained equations with averaged predictions and adjusted standard errors for uncertainty. Multinomial logistic regression analysis was used to separately identify predictors of endovascular and open BTA repair [versus nonoperative management (NOM)] after adjustment for demographic characteristics, comorbid conditions, and injury severity/location. A separate multinomial logistic regression was then used to identify predictors of in-hospital mortality after BTAI. A total of 5767 adult patients with BTAI who survived initial ED triage and who were without any injuries deemed nonsurvivable were included for analysis. Of these patients, 3,319 (57.6%) underwent NOM while 2448 (42.5%) underwent operative repair [2022 (35.1%) endovascular repair and 427 (7.4%) open repair]. Patients with higher-severity BTAI and those treated at community hospitals were more likely to undergo open repair (versus NOM), while older patients, those with hypotension in the ED, and those with concomitant head injury were less likely to undergo open repair. Higher-severity BTAI was also associated with an increased likelihood of endovascular repair (versus NOM), but uninsured patients and females were less likely to receive endovascular repair. Numerous factors were associated with in-hospital mortality after BTAI, including advanced age [AOR (95% CI) 3.29 (2.69, 4.01; P < .001] and lack of insurance [AOR 1.77 (95% CI 1.43,2.19; P < .001 versus Private/Commercial Insurance]. Both open repair [AOR 0.39 (95% CI 0.28, 0.53; P < .001] and endovascular repair [AOR 0.21 (0.17,0.26; P < .001] were associated with decreased risk-adjusted mortality when compared with NOM. Our study represents one of the largest contemporary analyses of BTAI management. Despite the significant survival advantage associated with repair, a majority of BTAI patients are managed nonoperatively. Several factors besides injury pattern seem to influence BTAI management, including patient gender and insurance status.