Cohort Study on the Prevalence and Risk Factors for Delayed Pulmonary Complications in Adults Following Minor Blunt Thoracic Trauma

Abstract

Objectives: The objectives of this study are to determine the prevalence, risk factors, and time to onset of delayed hemothorax and pneumothorax in adults who experienced a minor blunt thoracic trauma. Method: A prospective cohort of 450 consecutive patients was recruited. Eligible patients had to be over 16 years of age, consulted within 72 hours for a trauma, and available for outpatient follow-up at 2, 7, and 14 days posttrauma. The clinical outcome investigated was the presence of delayed pneumothorax or hemothorax on the follow-up chest x-ray. Outcomes: Delayed hemothorax occurred in 11.8% (95% CI 8.8-14.8), and delayed pneumothorax occurred in 0.9% (95% CI 0.2-2.3) of participants. During the 14-day follow-up period, 87.0% of these delayed complications developed in the first week. In the multivariate analysis, the only statistically significant risk factor for delayed complications was the location of fractures on the x-ray of the hemithorax. The adjusted odds ratio was 1.52 (95% CI 0.62-3.73) for the lower ribs (tenth to twelfth rib), 3.11 (95% CI 1.60-6.08) for the midline ribs (sixth to ninth rib), and 5.05 (95% CI 1.80-14.19) for the upper ribs (third to fifth rib) versus patients with no fractures. Conclusion: The presence of at least one rib fracture between the third and ninth rib on the x-ray of the hemithorax is a significant risk factor for delayed hemothorax and pneumothorax. RÉ SUMÉObjectifs: Les objectifs de cette é tude consistent à dé terminer la pré valence, les facteurs de risque, et le dé lai d'apparition de l'hé mothorax et du pneumothorax tardifs chez les adultes ayant subi un traumatisme thoracique mineur fermé . Mé thode: Une cohorte prospective de 450 patients consé cutifs a é té recruté e. Les patients é ligibles devaient ê tre â gé s de plus de 16 ans, avoir consulté en deç à de 72 heures pour un traumatisme et ê tre disponibles pour un suivi ambulatoire à 2, 7, et 14 jours suivant le traumatisme. Le ré sultat clinique recherché é tait la pré sence d'hé mothorax et de pneumothorax tardifs à la radiographie pulmonaire de contrô le. Ré sultats: L'hé mothorax tardif est survenu chez 11,8% (IC 95% 8,(8)(9)(10)(11)(12)(13)(14)8) and le pneumothorax tardif chez 0.9% (IC 95% 0,2-2,3%) des participants. Au cours de la pé riode de suivi de 14 jours, 87,0% de ces complications tardives se sont manifesté es durant la premiè re semaine. En analyse multivarié e, le seul facteur de risque de complications tardives statistiquement significatif é tait la localisation des fractures sur la radiographie de l'hé mithorax. Le rapport de cote ajusté se situe à 1,52 (IC 95% 0,62-3,73) pour les cô tes infé rieures (10-12e cô te), à 3,11 (IC 95% 1,6-6,08) pour les cô tes mé dianes (6-9e cô te), et à 5,05 (IC 95% 1,80-14,19) pour les cô tes supé rieures (troisiè me-cinquiè me cô te) par rapport aux patients sans fracture. Conclusion: La pré sence d'au moins une fracture de cô te entre la troisiè me et la neuviè me cô te à la radiographie de l'hé mithorax est un facteur de risque significatif d'hé ...

Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study

“…This incidence was less than in the rib fracture(s) group, an injury known to be associated with delayed pulmonary complications, including hemothorax. 13 None of the delayed hemothoraces in the sternal fracture group were managed with drainage, raising questions about the clinical significance of these radiologic findings. This situation could arise from the small number of isolated sternal fracture presenting with delayed hemothorax (n = 4) in our cohort, or could be that significant delayed hemothorax is rarely associated with isolated sternal fracture.…”

“…13,14,17 Patients ages 16 years and over who presented to the ED with a minor thoracic injury were screened for eligibility. Minor thoracic injury was defined by the presence of chest abrasion or contusion, or suspected or radiographically confirmed rib fracture.…”

“…11 Delayed hemothorax has been reported as an important complication with patients with minor thoracic injuries discharged from the ED, with an incidence of 7.4% of blunt thoracic injuries reported in Europe 12 and 11.8% in North America. 13 However, the only published prospective studies addressing delayed complications of minor thoracic injuries did not specifically assess isolated sternal fractures. [12][13][14] Moreover, very few authors have studied functional outcome or pain experienced by patients with minor thoracic injuries or sternal fracture after ED discharge.…”

“…13 However, the only published prospective studies addressing delayed complications of minor thoracic injuries did not specifically assess isolated sternal fractures. [12][13][14] Moreover, very few authors have studied functional outcome or pain experienced by patients with minor thoracic injuries or sternal fracture after ED discharge. [14][15][16][17] The purpose of this study was to determine and compare complications and outcomes of patients with isolated sternal fracture discharged from the ED to those with other minor thoracic injury.…”

Evaluation and treatment of trauma related collapse in athletes

“…Unfortunately, mortality from these injuries is very high but some injuries may be repairable [38,47]. Risk factors for internal injury to vascular structures after chest wall trauma are not well defined but multiple rib fractures, particularly higher ribs (above 9) with a high energy mechanism should raise suspicion [47,48].…”