MSS09: PRACTICE PATTERNS OF BLUNT AORTIC INJURY FOLLOWING PUBLICATION OF HARBORVIEW CLASSIFICATION WITHIN A MILITARY TRAUMA CENTER
Maria Eugenia Navarro, MD1; Ashley N Flinn Patterson, MD1; Ania Rogalska, MD2; Theodore Hart1; Marlin Wayne Causey, MD1; 1Brooke Army Medical Center; 2UT Health San Antonio Department of Surgery
Objectives: Society for Vascular Surgery (SVS) classification of blunt aortic injury is descriptive but fails to guide therapy. In the advent of publication and implementation of Harborview’s simplified classification scheme among three groups (minimal, moderate and severe) with consideration for treatment and follow-up, timing of operative management, if at all indicated, has been re-scrutinized. This study aims to classify trends in treatment in the period prior to and following publication of this new classification scheme in the military’s only Level 1 trauma center.
Methods: A retrospective review was conducted of trauma patients who presented with blunt aortic injury requiring operative management to Brooke Army Medical Center between 2011 and 2023. Variables including SVS classification scheme for blunt aortic injury, Harborview classification, time from injury and presentation to thoracic endovascular aortic repair (TEVAR) were collected and compared. Eras were defined pre- and post-publication of Harborview’s simplified classification scheme in 2016. Early intervention was defined as operative management within the first 24 hours of the patient’s arrival to the treatment center.
Results: 58 trauma patients were included in the study, 20 (34%) of which underwent TEVAR in the early era (defined as prior to 2016 or publication of the Harborview classification) and 38 (66%) following. There were nine patients in the minimal classification encompassing SVS classes I and II (16%), 38 moderate (SVS class III, 66%) and 11 severe (SVS class IV, 18%). In evaluating time to intervention from arrival to the treatment facility, there is a noted significant delay in time to treatment regardless of classification in the late era (20 hours versus 38 hours in the early era; p = 0.043), absent a difference in aortic related mortality and overall mortality (p = 0.012). Comparatively, 52% of patients classified as Harborview moderate underwent delayed operative management in the late era (average time = 65.6 hours) versus 15% in the era prior (average time = 20.3 hours; p = 0.03).
Conclusion: While severe aortic injuries require immediate repair, minimal to moderate injuries can be addressed following management of accompanying injuries and patient stabilization and that delay in treatment may be beneficial in most patients.