Can Transesophageal Echocardiography Accurately Diagnose Traumatic Aortic Injury? Goarin et al.(page 1373)
Survival of patients who sustain traumatic aortic injury as a result of blunt trauma (from motor vehicle or falling accidents) depends on early and accurate diagnosis. Goarin et al. evaluated the effectiveness of transesophageal echocardiography (TEE) to diagnose traumatic aortic injury in a large population of blunt trauma patients.
During the 9-yr study period, 209 of the 1,890 patients admitted to the center met the study inclusion criteria of enlargement of the mediastinum, sudden deceleration, or both. For 142 patients, the cause of trauma was a motor vehicle accident; for 69, a fall caused the trauma. One patient of the 209 underwent emergency aortic surgery and died. The team performed TEE and angiography in the remaining 208 patients and diagnosed traumatic aortic injury in 42 (20%).
Angiography (aortography or contrast-enhanced computed tomography) was less accurate than TEE in diagnosing aortic injury because it could not be used to diagnose most of the minor injuries, such as intramural hematoma or limited intimal flap. However, when considering only patients with major aortic injury who might need surgery, TEE and angiography were equivalent. Although the investigators were not blinded to the diagnostic method, and some variations in technique occurred during the study, TEE distinguished major from minor aortic injury, thus aiding in decision making regarding indications for emergency or delayed surgery.