Management Strategy is Not Predictive of Mortality after Blunt Aortic Injury in Children

Abstract To improve treatment algorithms for blunt aortic injury (BAI) in the endovascular era, we investigate predictors of mortality and compare outcomes by management strategy. The Trauma Quality Program national database was queried for BAI in patients ≤ 18 years from 2016 to 2022. Survivors, emergency department (ED) mortalities, and inpatient mortalities were compared. Predictors of inpatient mortality were identified via logistic regression. Outcomes were compared by management strategy (non-operative [NOM], endovascular [EM], vs. operative [OM]). Comparisons were performed via Kruskal-Wallis or chi-square tests. p-Values < 0.05 were considered significant. A total of 359 patients were included. The median age was 16 [IQR 12, 18] years. Of the total patients 298 (83%) underwent NOM, 21 (5.8%) OM, and 40 (11%) EM. Overall mortality was 27% (14% ED, 13% inpatient). On multivariable analysis, management style (endovascular: OR 0.39 [0.1, 1.25], p = 0.135, operative: OR 3.82 [0.76, 16.7], p = 0.082 vs. NOM), age (OR 1.03 [0.93, 1.14], p = 0.608), sex (OR 0.64 [0.27, 1.56], p = 0.323), location of aortic injury (thoracic vs. abdominal, OR 1.38 [0.56, 3.45], p = 0.491), and severity of aortic injury (OR 1.11 [0.45, 2.73], p = 0.883) were not significant predictors of inpatient mortality. Rather, Injury Severity Score (ISS) (OR 1.06 [1.03, 1.11], p = 0.001) and head injuries (OR 7.85 [2.92, 23.21], p < 0.001) were significant predictors of mortality. While limited by lack of detailed injury grading in this database study, after adjustment for age, sex, injury severity, head injuries, location of aortic injury, and severity of aortic injury, management strategy (endovascular, operative, non-operative) was not a significant predictor of inpatient mortality after BAI in this analysis. ISS and severe head injuries were predictive of mortality in these cases.