A new classification scheme for treating blunt XXXX .

@entity1 @entity1004 @entity397 @entity1410 @entity715 @entity551 @entity2849 @entity130
BACKGROUND: There are numerous questions about the treatment of blunt @entity130 (BAI), including the management of small intimal tears, what injury characteristics are predictive of death from @entity397 , and which @entity1 actually need intervention. We used our experience in treating BAI during the past decade to create a classification scheme based on radiographic and clinical data and to provide clear treatment guidelines. METHODS: The records of @entity1 admitted with BAI from 1999 to 2008 were retrospectively reviewed. @entity1 with a radiographically or operatively confirmed diagnosis (echocardiogram, computed tomography, or angiography) of BAI were included. We created a classification system based on the presence or absence of an aortic external contour abnormality, defined as an alteration in the symmetric, round shape of the aorta: (1) intimal tear (IT)-absence of aortic external contour abnormality and intimal defect and/or @entity715 of <10 mm in length or width; (2) @entity1004 ( @entity1004 )-absence of aortic external contour abnormality and intimal defect and/or @entity715 of >= 10 mm in length or width; (3) @entity2849 -presence of aortic external contour abnormality and contained @entity397 ; (4) @entity397 -presence of aortic external contour abnormality and free contrast extravasation or hemothorax at thoracotomy. RESULTS: We identified 140 @entity1 with BAI. Most injuries were @entity2849 (71%) at the isthmus (70%), 16.4% had an IT, 5.7% had a @entity1004 , and 6.4% had a @entity397 . Survival rates by classification were IT, 87%; @entity1004 , 100%; @entity2849 , 76%; and @entity397 , 11% (one @entity1 ). Of the ITs, LIFs, and @entity2849 treated nonoperatively, none worsened, and 65% completely healed. No @entity1 with an IT or @entity1004 died. Most @entity1 with @entity397 lost vital signs before presentation or in the emergency department and did not survive. @entity551 before or at hospital presentation and size of the periaortic @entity1410 at the level of the aortic arch predicted likelihood of death from BAI. CONCLUSIONS: As a result of this new classification scheme, no @entity1 without an external aortic contour abnormality died of their BAI. ITs can be managed nonoperatively. BAI @entity1 with @entity397 will die, and resources could be prioritized elsewhere. Those with LIFs do well, and currently, most at our institution are treated with a stent graft. If a @entity2849 is going to @entity397 , it does so early. @entity1410 at the arch on computed tomography scan and @entity551 before or at arrival help to predict which @entity2849 need urgent repair.
