Predictors of outcome in blunt chest trauma
ABSTRACT Thoracic trauma is often associated with polytrauma. Because mortality is high, the search for prognostic tools is useful.
A total of 108 patients with blunt thoracic trauma, 73 of whom had multiple injuries, were studied in an intensive care unit (ICU). The variables named as potential predictors of outcome were the need for mechanical ventilation, duration of ventilation, and high positive end-expiratory pressure (PEEP); the presence of rib fractures, pulmonary contusion, pleural involvement (hemo- and/or pneumothorax), or lung infection; the need for emergency surgery; mean duration of ICU stay, and age. We also studied whether or not the mortality rate was higher in polytrauma patients. Student t and chi2 tests (95% confidence level) and multiple regression analysis (Hosmer-Lemeshow goodness of fit) were used to analyze the results.
The need for mechanical ventilation, radiographic evidence of pulmonary contusion, emergency surgery, and hemodynamic instability were risk factors for increased mortality. Higher risk of mortality was not demonstrated for patients with multiple injuries. For patients in need of mechanical ventilation, high PEEP was a predictor of poor prognosis.
The presence of the aforementioned predictors (mechanical ventilation, high PEEP, pulmonary contusion, emergency surgery, and hemodynamic instability) indicate serious injury to the lung parenchyma, which is the main determinant of outcome for patients with thoracic trauma.
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ABSTRACT: OBJECTIVE: To describe the clinical characteristics and risk factors of patients with chest trauma, and to evaluate their correlation with the development of complications. METHODS: Descriptive, prospective and analytical study of a patient cohort with chest trauma who underwent follow-up for a period of 30days. Excluded from the study were those patients with moderate to severe traumatic brain injury, long-bone fractures, abdominal trauma and patients requiring mechanical ventilation. RESULTS: A total of 376patients met the inclusion criteria, 220 of whom were males (58.5%). The most frequent causes of trauma were falls (218cases; 57.9%) and motor vehicle accidents (57cases; 15.1%). The most frequent type of trauma was rib contusion (248cases; 65.9%) and rib fractures (61cases; 16.2%). Complications were observed in 43patients (11.4%), mainly hemothorax (13cases), pneumothorax (9cases), pneumonia (6cases) and acute renal failure (4cases). Four patients died due to pneumonia and hemothorax. Thirty-three patients were hospitalized (8.7%) and 10 (2.6%) required later re-admittance. The risk for complications increased significantly in patients with more than 2rib fractures, in those over the age of 85 and in the presence of certain comorbidities, such as COPD and pathologies requiring anticoagulation therapy. The risk for re-admittance is higher in patients over the age of 60. CONCLUSIONS: Patients with chest trauma who present certain comorbidities, are over the age of 85 and have more than 2rib fractures may present more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects.Archivos de Bronconeumología 02/2013; · 2.17 Impact Factor
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ABSTRACT: This prospective study was carried out to compare the outcome of lung sparing damage control surgery versus major pulmonary resections for extensive thoracic trauma. Methods: The study analyses the results of 52 trauma victims who underwent thoracotomy for pulmonary injuries over a period of 5 years. Operative techniques, postoperative complications and mortality were assessed in both groups, results analysed with the help of Fisher’s exact test and Chi-square test and the analysis of variance for comparative analysis carried out with SPSS 10.0. Results: Penetrating trauma was the main cause of thoracic injuries affecting 39/52 patients. Associated injuries were found in 9/13 blunt trauma victims, but only in 11/39 penetrating trauma sufferers. The morbidity and mortality were significantly higher after major resections, 6/11 and 2/11, as compared to lung sparing surgery, 10/41 and 2/41, respectively (p = 0.001). Conclusion: We recommend the use of lung sparing damage control techniques to manage major thoracic trauma requiring surgical intervention. Lung sparing surgery is an effective and much safer option as compared to major pulmonary resection when treating extensive lung trauma.European Journal of Trauma 04/2006; 32(2):185-189. DOI:10.1007/s00068-006-6023-3
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ABSTRACT: Chest trauma is an important trauma globally accounting for about 10% of trauma admission and 25-50% of trauma death. Different types and severity of chest trauma in different subsets of patients with varying associated injuries result in differing outcomes measured with mortality. Early mitigation of poor prognostic factors could result in improved outcome, therefore the need to know such factors or determinants of mortality in chest trauma patients. Retrospective and prospective analysis of demographic details, socio-economic, clinical details, modified early warning signs (MEWS) score on presentation, investigation findings, treatment and outcome of chest trauma patients who presented to our cardiothoracic surgery unit was undertaken. Data were collected and were analyzed using WINPEPI Stone Mountain, Georgia: USD Inc; 1995 statistical software. A total 149 patients with thoracic trauma were studied over a 5 year period constituting 40% of the unit workload. There were 121 males and 28 females (81.2% vs. 18.8%; m: f = 4:1) with age range from 7 to 76 years (mean: 37.42 ± 12.86 years) and about 55% aged 45 years or below and more blunt trauma than penetrating trauma (65.1% vs. 34.9%), but no statistical significance amongst the groups on outcome analysis. Sub-grouping of the 149 patients according to their on-admission MEWS score shows that 141 patients had scores of 9 and less and all survived while the remaining eight had scores >9 but all died. As independent variables, age, sex and type of chest injury did not prove to be correlated with mortality with P values of 0.468, 1.000 and 1.000 respectively. However presence of associated extra thoracic organ injury, high on-admission MEWS score >9, delayed presentation with injury to presentation interval longer than 24 h, and severe chest injury as characterized by bilateral chest involvement correlated positively with mortality with P values of 0.0003, 0.0001, 0.0293 and 0.0236 respectively. Associated extra thoracic organ injury, high on-admission MEWS score >9, late presentation beyond 24 h post trauma and severe chest injury with bilateral chest involvement were found to be determinants of mortality in chest trauma.03/2014; 20(1):30-4. DOI:10.4103/1117-6806.127107