Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study

Beshay, Morris; Mertzlufft, F.; Kottkamp, Hans; Reymond, Marc A.; Schmid, Ralph A.; Branscheid, D.; Wähnert, Dirk

doi:10.1186/s13017-020-00324-1

Cited by 57 publications

(51 citation statements)

References 25 publications

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“…The present study found a lower incidence of thoracic trauma compared to that reported elsewhere [9,22,23]. This was probably underestimated herein as those suffering minor thoracic injuries (AIS Thorax =1), including single rib fractures, were excluded.…”

Section: Discussioncontrasting

confidence: 61%

“…Although it is a register study with the known weaknesses, the present multicentre study is based on data prospectively collected over a 20-year-period from level I to III trauma centres and included patients of all ages whereas many studies focused on thoracic trauma are single centre studies and only included patients ≥ 16 years [5,8,12,17,22,37]. Thus, our ndings are generalisable to other high-income countries.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Thoracic Trauma on the Mortality of Multi-trauma Patients: It Matters - Results From a French Road Trauma Registry 1997-2016

Benhamed

Ndiaye

Lieutaud

et al. 2021

Preprint

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BackgroundThoracic trauma is the third most common cause of death in multi-trauma patients and is associated with poor short-term outcomes since it is responsible for up to 25% of trauma-related deaths. One of the most frequent mechanism is road traffic accident (RTA), affecting particularly young patients. The primary objective of the present study was to investigate the influence of severe injuries in each body region on the mortality of multi-trauma patients with a particular attention to thoracic trauma. Secondary objectives were to investigate risk factors for mortality in multi-trauma patients but also to describe the epidemiology and injury pattern of these patients when presenting with at least one abbreviated injury scale (AIS) ≥2 thoracic injury (AISThorax≥2).MethodsRetrospective study that included RTA occurring from January 1997 to December 2016. Patients of all ages included in the Rhône RTA registry, with at least one AIS ≥2 injury in any body region were included. Two subgroups were defined according to whether patients presented at least one AISThorax≥2 injury or not. Multivariate regression analysis with mortality as outcome was performed. ResultsA total of 46,526 patients had at least one AIS≥2 injury, among them 6,382 (13.7%) had at least one AISThorax≥2 injury. In the AISThorax≥2 group, the median [IQR] ISS was 14 [6-7] and 16.2% (n=1,031) patients died. Severe (AIS≥3) head (OR=26.8, 95%CI [20.4;35.2]) and thoracic (OR=12.2, 95%CI [8.4;17.7]) injuries were associated with death; as was age [40-59 years (OR=1.3, 95%CI [1.1;1.5]), 60-79 years (OR=2.1, 95%CI [1.7;2.6]), and ≥80 years (OR=5.5, 95%CI [4.2;7.3])], male sex (OR=1.5, 95%CI [1.3;1.7]), RTA occurring in a highway (OR=1.9, 95%CI [1.5;2.4]) or in a rural road (OR=1.8, 95%CI [1.5;2.1]). The most frequent thoracic injury was that of the chest wall (62.1%, n=5,419). The most frequent concomitant AIS≥2 injuries affected the head (29.1%), upper extremities (26.8%), and lower extremities (25.8%).ConclusionsThe present study found that the severity of thoracic trauma was an independent and significant risk factor for death in multi-trauma patients as was age, being a car occupant and having a crash in a rural road or a highway.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Impact of Thoracic Trauma on the Mortality of Multi-trauma Patients: It Matters - Results From a French Road Trauma Registry 1997-2016

Benhamed

Ndiaye

Lieutaud

et al. 2021

Preprint

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“…Similar to other nations, credits would be given to economic growth, and authorities efforts for continuously promoting public safety awareness, enforcing the use of helmets and seat-belts, combatting speeding and drunk driving, and advocating for safer vehicles over the years [ 12 , 14 , 15 ]. Furthermore, newly instituted regional trauma centers with standardized, optimized managing protocol and dedicated task forces are also playing key roles [ 8 , 16 ]. Yet no reductions in the number of RTCR chest injury deaths have been observed throughout the study period, which underlines the importance of keep strengthening strategies to mitigate key risk factors and to improve road safety [ 17 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and clinical characteristics of road traffic crashes related thoracic traumas: analysis of 5095 hospitalized chest injury patients

Zhang

Xiao

Wang

et al. 2021

J Cardiothorac Surg

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Background Road traffic crashes related (RTCR) chest traumas remain important global public health challenge. The impact of boosting market of automobile vehicles in China during last decade on thoracic injury needs to be defined. This study aimed to review and analyze the demographic and clinical characteristics of RTCR thoracic injuries in China. Methods Clinical records of patients with thoracic trauma admitted to thoracic surgery department between January 2003 and June 2020 were retrospectively retrieved and reviewed. Patients’ profiles and clinical characteristics were comparatively analyzed between road traffic crashes caused injury and other injury mechanisms, and in RTCR chest trauma patients before January 2011 (2003 group), and after January 2011 (2011 group), when is considered as the beginning year of Chinese household vehicle era. Results The study included 5095 thoracic trauma patients with mean age of 50.2 years, of whom 79.4% were male. Most of the patients (70.3%, n = 3583) had rib fractures. Associated injuries were present in 52.0% of the patients, of them 78.5% (n = 2080) were extremity fractures. Road traffic crashes accounted for 41.4% (n = 2108) of the injuries, most of them (98.0%) were related to motor vehicles. In comparison with other chest trauma mechanisms, RTCR chest injuries affected females and older males more frequently, with a higher incidence of rib fractures and sternum fractures, and higher injury severity scores (ISS) (all p < 0.05). Surgeries were required in 1495 (70.9%) patients of the RRTCR chest traumas, while the majority of non-RTCR thoracic injuries were managed conservatively or with tube thoracostomy (30.2%, n = 901). RTCR chest traumas caused longer hospital stay (13.0 ± 9.6 days vs. 11.8 ± 7.4 days, p = 0.001), higher ICU usage (30.7% vs. 19.6%, p = 0.001), higher rate of ventilator support (12.9% vs. 7.5%, p = 0.001), and higher mortalities (3.8% vs. 1.6%, p = 0.005) than that of non-RTRA chest injuries. For RTCR patients, when compared with 2003 group, 2011 group had similar patterns in terms of accident category, associated injury and treatment. However, 2011 group had more females (38.5% vs. 18.0%, p = 0.001) and older males (50.6 ± 9.7 vs. 47.9 ± 17.2, p = 0.001), with a higher ISS (18.3 ± 10.2 vs. 17.1 ± 8.9, p = 0.004), and fewer were managed with chest tubes (25.0% vs. 29.2%, p = 0.031). Clinical outcomes were not significantly different between the groups in terms of hospital length of stay, intensive care unit (ICU) usage, ICU length of stay, duration of ventilator hours and mortality. However, the 2011 group had more patients requiring ventilator support (14.4% vs. 10.6%, p = 0.011). Conclusions Road traffic crashes remain to be the major etiology of thoracic injuries in China, which usually affects middle-aged males, causing rib fractures with concomitant injuries frequently occurring to other organ systems. Treatments mainly include tube thoracotomy and surgical procedures. Although the clinical characteristics and outcomes of traffic accident related chest traumas are largely unchanged in spite of the rapid increasing numbers of motor vehicles, variations in the pattern of injuries by gender, age, injury severity and ventilator usage may still provide important information for targeted management.

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“…Blunt abdominal trauma is the leading cause of intra-abdominal injury with motor vehicle accidents being the leading cause of blunt abdominal trauma. Sports injuries and falls are some of the other causes (1) . Abdominal trauma is generally divided into blunt and penetrating trauma.…”

Section: Introductionmentioning

confidence: 99%

Solid Organs Injuries in Blunt Abdominal Trauma Patients

Abo-Elhoda

Attia

Ahmed

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Trauma is a major public health problem worldwide, morbidity and mortality in solid organ injuries (SOIs) following blunt abdominal trauma are often related to the severity of associated injuries. The management of SOIs depends upon the hemodynamic status of the patients. Hemodynamically unstable patients often require surgical management. Nonoperative management (NOM) is preferred in hemodynamically stable patients. Objective: This study was conducted to detect both incidence of solid organs injuries in blunt abdominal trauma patients and pattern of injuries as well as outcome in operative management comparing to non-operative management patients. Patients and methods: During the study period, total number of 6908 polytrauma patients presented to Mansoura University Emergency Hospital. Among them 685 (9.9%) presented by abdominal trauma. There were 173 cases with penetrating abdominal trauma and 512 cases with blunt abdominal trauma (BTA). Among the cases with BAT, 268 cases were excluded and the remaining 244 were included in the current study. Results: The most common cause of trauma was road traffic accidents (RTA) (64.3%) of the cases. Solid organs were affected in (70.1%) of the cases, bowels and other abdominal organs were affected in (24.2%), combined solid organs and other abdominal injuries were detected in (5.7%) of the cases. Spleen was the most affected organ in 55.1% of the cases. Total operative management (OM) was required in 70 cases (37.8%) and total NOM was required in 115 cases (62.2%). The overall incidence of mortality was 5.4%. There was no statistically significant difference in the length of hospital stay between the cases according to management (operative or non-operative). Conclusion: Hemodynamically stable blunt abdominal trauma with solid organ injury may be managed safely using a NOM approach.

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Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study

Cited by 57 publications

References 25 publications

Impact of Thoracic Trauma on the Mortality of Multi-trauma Patients: It Matters - Results From a French Road Trauma Registry 1997-2016

Impact of Thoracic Trauma on the Mortality of Multi-trauma Patients: It Matters - Results From a French Road Trauma Registry 1997-2016

Epidemiological and clinical characteristics of road traffic crashes related thoracic traumas: analysis of 5095 hospitalized chest injury patients

Solid Organs Injuries in Blunt Abdominal Trauma Patients

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