With an extensive background in vascular surgery, Georgia physician Dr. Robert Crawford has worked with critical care patients in addressing injuries of the brain and aorta. Published in his field, Robert Crawford, MD, took part in research disseminated by the Society of Vascular Surgery through its Journal of Vascular Surgery, entitled “A new aortic injury score predicts early rupture more accurately than clinical assessment.”
The main focus of the study was the evaluation of high-grade blunt thoracic aortic injury (BTAI) repairs, and the precise timing of that repair for optimal outcomes. The research showed, that in many cases, delayed repair of selected aortic injuries, improves outcomes for the concurrent brain injury. A pilot clinical risk score was thus developed for evaluating aortic stability and predicting early rupture.
The methodology involved a retrospective review of computed tomography (CT) diagnosed BTAI patients, in stable condition. Those patients who progressed to aortic rupture were compared with patients who did not undergo intervention within 48 hours of admission. A novel aortic risk score was then calculated, based on clinically relevant factors that included aortic lesion size, mediastinal hematoma extent, and patient physiology. These encompassed both clinical and radiographic factors.
The model provided a score for more reliably distinguishing between stable and unstable lesions than was possible with clinical assessment, easily performed at the bedside. Because the interval between CT and rupture tends to be short, the score may be useful in identifying those patients with unstable lesions, and who thus need prioritized emergency aortic repair. Further research showed be able to refine the model and identify other factors that may contribute to stability versus rupture.
The main focus of the study was the evaluation of high-grade blunt thoracic aortic injury (BTAI) repairs, and the precise timing of that repair for optimal outcomes. The research showed, that in many cases, delayed repair of selected aortic injuries, improves outcomes for the concurrent brain injury. A pilot clinical risk score was thus developed for evaluating aortic stability and predicting early rupture.
The methodology involved a retrospective review of computed tomography (CT) diagnosed BTAI patients, in stable condition. Those patients who progressed to aortic rupture were compared with patients who did not undergo intervention within 48 hours of admission. A novel aortic risk score was then calculated, based on clinically relevant factors that included aortic lesion size, mediastinal hematoma extent, and patient physiology. These encompassed both clinical and radiographic factors.
The model provided a score for more reliably distinguishing between stable and unstable lesions than was possible with clinical assessment, easily performed at the bedside. Because the interval between CT and rupture tends to be short, the score may be useful in identifying those patients with unstable lesions, and who thus need prioritized emergency aortic repair. Further research showed be able to refine the model and identify other factors that may contribute to stability versus rupture.
