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Field ML, Bashir M, Sastry P, Cuerden R, Richens D

Defining acute aortic syndrome following trauma: are abbreviated injury scale (AIS) codes a useful surrogate descriptor?. Field ML, Bashir M, Sastry P, Cuerden R, Richens D. Aortic rupture. http://uk.wrs.yahoo.com. Intimal tear. IMH. http://www.lightlabimaging.com/gallery/cvpstill.html.

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Field ML, Bashir M, Sastry P, Cuerden R, Richens D

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  1. Defining acute aortic syndrome following trauma: are abbreviated injury scale (AIS) codes a useful surrogate descriptor? Field ML, Bashir M, Sastry P, Cuerden R, Richens D Aortic rupture http://uk.wrs.yahoo.com Intimal tear IMH http://www.lightlabimaging.com/gallery/cvpstill.html Acute aortic syndrome. Heart 2001;85:365–368

  2. Background • Vehicle related blunt traumatic aortic injury typically results in exsanguination and fatality • A small percentage of patients sustain a lesser, partial thickness aortic injury or contained rupture, allowing transfer to hospital • The spectrum of aortic injuries included in the description of acute aortic syndrome include: intimal tear, intramural haematoma, localised dissection, contained and uncontained rupture

  3. Objective • To use Abbreviated Injury Scale (AIS) codes, used in trauma data bases, as a surrogate marker for entities within the spectrum of acute aortic syndrome Hypothesis • The kinematics of injury are distinct for partial thickness intimal tears and mural haematoma versus full thickness rupture

  4. Results I – Abbreviated Injury Scales (AIS) codes Intimal injury Mural injury Rupture

  5. AAS matched to AIS codes

  6. Methods • As part of the UK Cooperative Crash Injury Study, which performs detailed vehicle related crash scene analysis, including equivalence test speed (ETS), seatbelt usage, seat position and impact direction, we examined victims with aortic injuries categorised by AIS codes 420200 to 420299

  7. Estimation of combined impact speeds in the Laboratory using vehicle deformation to calculate Estimated Test Speed (ETS)

  8. Results • Of over 16000 analysed crashes in the UK-CCIS database, 132 involved aortic injuries. • Using AIS codes as surrogate markers there were: • 9 initimal tears, • 22 intramural haematomas, • 42 localised dissections/ contained ruptures • 41 uncontained ruptures • Taking this selective group of 132 vehicle related fatalities with BTAI, we were able to relate entities within the spectrum of acute aortic disease to kinematics and mechanism of injury. • Risk of partial thickness aortic injuries is higher in front and far side impacts while full thickness uncontained ruptures are more likely in near side impacts.

  9. Results: Position in car

  10. Result:Direction of impact

  11. Relationship between Estimated Test Speed and Abbreviated Injury Score

  12. Conclusions • AIS codes may be matched to intimal tear, intramural haematoma, localized dissection and contained/ uncontained rupture • Mechanism of injury differs for entities within the spectrum of acute aortic syndrome • Risk of partial thickness injury is higher in frontal and far side impacts while rupture is more common in near side impacts • Refinement of “Thoracic Vascular” AIS codes in light of our current understanding of acute aortic syndromes would further aid analysis

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