BACKGROUND: The management of blunt thoracic aortic injury (BTAI) is evolving as the trauma population ages, yet the impact of age on treatment patterns and outcomes remains incompletely defined. STUDY DESIGN: A retrospective analysis of the Aortic Trauma Foundation registry (November 2016-November 2023) identified 823 patients with BTAI, including 118 geriatric patients (≥65 years). Demographics, injury characteristics, management strategies, and outcomes were compared between geriatric and younger (<65 years) cohorts. RESULTS: Geriatric patients more frequently presented after falls (17.8% vs 6.7%, p<0.0001) and had a higher proportion of grade IV injuries (18.5% vs 9.2%, p=0.0021), with no difference in admission systolic blood pressure (116 vs 116, p=0.960) or Injury Severity Score (31 vs 33, p=0.150). Management strategies were similar between groups, including nonoperative (37.3% vs 36.9%, p=0.932), open (4.2% vs 1.9%, p=0.132), and endovascular repair (58.5% vs 61.1%, p=0.584). Despite comparable treatment approaches, geriatric patients had higher in-hospital mortality (27.1% vs 10.9%, p<0.0001) and aortic-related mortality (8.5% vs 3.4%, p=0.010). CONCLUSIONS: Geriatric patients with BTAI sustain more severe injuries and experience significantly higher mortality despite similar management strategies. These findings suggest that current treatment paradigms may not adequately address age-associated risk and highlight the need for age-specific management considerations.
Gaither et al. (Mon,) studied this question.