Traumatic Aortic Disruption Index (TADI) Predicts Mortality and Urgency of Stent Grafting in Blunt Thoracic Aortic Pseudoaneurysms

Delayed stent grafting of blunt thoracic aortic (grade 3) pseudoaneurysms (BTAPs) is a standard practice, allowing focus on more acute life-threatening injuries. Which severe BTAPs require urgent intervention is currently unclear. We hypothesize that a Traumatic Aortic Disruption Index (TADI) based on sagittal computed tomography (CT) imaging would predict urgency of stent grafting in polytrauma patients. All BTAPs at a level-1 trauma center over 12-years were identified. TADI score was calculated utilizing pseudoaneurysm length (L), maximum injury width (W), and normal adjacent aortic diameter (NA) on a CT image (Fig 1). Patient presentation, timing of stent grafting, and outcomes were then evaluated. Forty-two patients were diagnosed with BTAP. Mean age was 37.6 years, with median injury severity score (ISS) of 29. Overall mortality was 11.9% (aorta-related, n = 3; 60%; traumatic brain injury [TBI], n = 2; 40%). TADI scores ranged from 3.6 to 158.6. Compared with patients with TADI <28 (n = 21), patients with TADI >28 (n = 21) had similar median ISS scores (34 vs 29; P = .16) and rates of both TBI (33.3% vs 42.0%; P = .53) and non-TEVAR hemorrhage control procedures (44.4% vs 33.3%; P = .3). However, patients with TADI >28 had lower presentation mean systolic blood pressure (98.5 mmHg vs 121.9 mmHg; P = .003) and higher overall mortality (23.8% vs 0%; P = .048). Patients with TADI >28 received stent grafting at significantly shorter time intervals (median 4 vs 14 hours; P = .001). In subgroup analysis of patients with TBI (n = 16), overall median time from injury to stent grafting was 5 hours. Patients with TADI>28 and TBI received stent grafting at significantly shorter time intervals than patient with TADI <28 and TBI (median 3 vs 10 hours; P = .026). This simple-to-calculate score predicted mortality and urgency of stent grafting in polytrauma patients with similar ISS and rates of TBI. TADI should be validated in a larger prospective study as an injury prioritization tool in trauma patients with BTAPs.