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Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience

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Abstract

A review of prospectively collected data in our trauma unit for the years 1998–2003 was undertaken. Adult patients who suffered multiple trauma with an Injury Severity Score (ISS) of ≥16, admitted to hospital for more than 72 hours and with sustained blunt chest injuries were included in the study. Demographic details including pre-hospital care, trauma history, admission vital signs, blood transfusions, details of injuries and their abbreviated injury scores (AIS), operations, length of intensive care unit and hospital stays, Injury Severity Score (ISS) and mortality were analysed. Fulfilling the inclusion criteria with at least one chest injury were 1,164 patients. The overall mortality reached 18.7%. As expected, patients in the higher AIS groups had both a higher overall ISS and mortality rate with one significant exception; patients with minor chest injuries (AISchest = 1) were associated with mortality comparable to injuries involving an AISchest = 3. Additionally, the vast majority of polytraumatised patients with an AISchest = 1 died in ICU sooner than patients of groups 2–5.

Résumé

Nous avons pratiqué une revue prospective des données de notre unité de traumatologie pour l'année 1998 à 2003. Les patients présentant des polytraumatismes sévères et dont le score ISS était de 16, admis à l'hôpital pour plus de 72 heures et présentant des traumatismes thoraciques ont été inclus dans cette étude. Les détails démographiques, les traitements pratiqués, l'histoire du traumatisme, les signes vitaux, les lésions vitales à l'admission, les transfusions sanguines, le détail des traumatismes selon le score AIS, les traitements en unité de soins intensifs ainsi que la durée de séjour, le score de sévérité des traumatismes et la mortalité ont été analysés. 1 164 patients présentant au moins un traumatisme thoracique ont été inclus. Le taux de mortalité a été de 18,7%. Les patients avec un score AIS élevé, associés à un score ISS élevé avaient un taux de mortalité significatif avec une exception significative pour les patients présentant un traumatisme thoracique minime (AIS thoracique = 1) associés à une mortalité comparable aux traumatismes de score AIS = 3. De plus, la grande majorité des patients polytraumatisés avec un score AIS = 1 sont décédés en unité de soins intensifs de façon plus précoce que les patients des groupes 2 à 5.

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References

  1. AAAM (1998) The Abbreviated Injury Scale, 1990 revision. American Association for the Advancement of Automotive Medicine, Des Plaines, Illinois

  2. Adams VI, Carrubba C (1998) The Abbreviated Injury Scale: application to autopsy data. Am J Forensic Med Pathol 19:246–251

    Article  PubMed  Google Scholar 

  3. Baker SP, O’Neill B, Haddon W Jr., Long WB (1974) The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    Article  PubMed  CAS  Google Scholar 

  4. Bergeron E, Lavoie A, Clas D et al (2003) Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma 54:478–485

    Article  PubMed  Google Scholar 

  5. Boulanger BR, Stephen D, Brenneman FD (1997) Thoracic trauma and early intramedullary nailing of femur fractures: are we doing harm? J Trauma 43:24–28

    Article  PubMed  CAS  Google Scholar 

  6. Boyd CR, Tolson MA, Copes WS (1987) Evaluating trauma care: the TRISS method. Trauma score and the Injury Severity Score. J Trauma 27:370–378

    Article  PubMed  CAS  Google Scholar 

  7. Bulger EM, Edwards T, Klotz P, Jurkovich GJ (2004) Epidural analgesia improves outcome after multiple rib fractures. Surgery 136:426–430

    Article  PubMed  Google Scholar 

  8. Bull JP (1978) Measures of severity of injury. Injury 9:184–187

    Article  PubMed  CAS  Google Scholar 

  9. Clark GC, Schecter WP, Trunkey DD (1988) Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma 28:298–304

    Article  PubMed  CAS  Google Scholar 

  10. Clarke JR, Ragone AV, Greenwald L (2005) Comparisons of survival predictions using survival risk ratios based on International Classification of Diseases, 9th revision and Abbreviated Injury Scale trauma diagnosis codes. J Trauma 59:563–567; discussion 567–569

    PubMed  Google Scholar 

  11. Gustavo Parreira J, Coimbra R, Rasslan S et al (2000) The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures. Injury 31:677–682

    Article  PubMed  CAS  Google Scholar 

  12. Hildebrand F, Giannoudis PV, Griensven M et al (2005) Management of polytraumatized patients with associated blunt chest trauma: a comparison of two European countries. Injury 36:293–302

    Article  PubMed  Google Scholar 

  13. Johnson JA, Cogbill TH, Winga ER (1986) Determinants of outcome after pulmonary contusion. J Trauma 26:695–697

    Article  PubMed  CAS  Google Scholar 

  14. Johnson KD, Cadambi A, Seibert GB (1985) Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma 25:375–384

    Article  PubMed  CAS  Google Scholar 

  15. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  PubMed  CAS  Google Scholar 

  16. Linn S (1995) The Injury Severity Score—importance and uses. Ann Epidemiol 5:440–446

    Article  PubMed  CAS  Google Scholar 

  17. Nast-Kolb D, Waydhas C, Jochum M et al (1990) Is there a favorable time for the management of femoral shaft fractures in polytrauma? Chirurg 61:259–265

    PubMed  CAS  Google Scholar 

  18. Osler T, Baker SP, Long W (1997) A modification of the Injury Severity Score that both improves accuracy and simplifies scoring. J Trauma 43:922–925; discussion 925–926

    Article  PubMed  CAS  Google Scholar 

  19. Pape HC, Remmers D, Rice J et al (2000) Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma 49:496–504

    Article  PubMed  CAS  Google Scholar 

  20. Richter M, Krettek C, Otte D et al (2001) Correlation between crash severity, injury severity, and clinical course in car occupants with thoracic trauma: a technical and medical study. J Trauma 51:10–16

    Article  PubMed  CAS  Google Scholar 

  21. Scalea TM, Boswell SA, Scott JD et al (2000) External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma 48:613–621; discussion 621–613

    Article  PubMed  CAS  Google Scholar 

  22. Schulman AM, Claridge JA, Carr G et al (2004) Predictors of patients who will develop prolonged occult hypoperfusion following blunt trauma. J Trauma 57:795–800

    Article  PubMed  Google Scholar 

  23. Snyder CL, Jain VN, Saltzman DA et al (1990) Blunt trauma in adults and children: a comparative analysis. J Trauma 30:1239–1245

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Peter V. Giannoudis.

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Veysi, V.T., Nikolaou, V.S., Paliobeis, C. et al. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. International Orthopaedics (SICOT) 33, 1425–1433 (2009). https://doi.org/10.1007/s00264-009-0746-9

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