Prediction Model for Blunt Thoracic Aortic Injury Evaluation in the Emergency Department

Abstract

Background

The diagnosis of blunt thoracic aortic injury (BTAI) is challenging. In this study, a prediction model with a simplified scoring system for BTAI was developed for the primary evaluation of trauma patients in the emergency department.

Methods

This retrospective cohort study included blunt chest trauma patients. Mediastinal width was measured using supine position X-rays. Other factors that may be associated with BTAI were also evaluated, including hemodynamics, associated hemothorax, sonographic examination results, and troponin I levels. Risk identification was performed using a logistic regression model, which led to establishment of the final model.

Results

A total of 418 patients with thoracic trauma were included in the study. Of them, 52 patients had BTAI. We found that a mediastinal width of >8.5 cm had a better predictive value than the conventional cutoff value of 8 cm. In multivariate logistic regression analysis, significant risk factors for BTAI included shock (odds ratio (OR): 2.12), left hemothorax (OR: 2.86), mediastinum width >8.5 cm (OR: 3.48), elevated troponin I levels (OR: 2.90), and pericardial effusion (OR: 6.03). The receiver operating characteristic curve (ROC) curve yielded an area under the curve (AUC) value of 0.754, demonstrating superior diagnostic accuracy compared with the use of mediastinal widening alone, which had an AUC of 0.632.

Conclusion

In addition to a widened mediastinum alone, a model that combines shock upon admission, elevated troponin I levels, left hemothorax, and pericardial effusion offers a straightforward, feasible, and acceptable screening method for BTAI.