Evaluation of risk factors for prognosticating blunt trauma chest

Abstract

<b>Introduction:</b> Blunt trauma chest contributes to significant number of trauma admissions globally and is a cause of major morbidity and mortality. Many scoring systems and risk factors have been defined in past for prognosticating blunt trauma chest but, none is considered to be gold standard. </br> <b>Aim:</b> This study was conducted to reassess the significance of available scoring systems and others indicators of severity in prognosticating blunt trauma chest patients. </br> <b>Materials and Methods:</b> In this prospective observational study from November 2016 till March 2018, 50 patients with age more than 12 years with blunt chest trauma who required hospitalization were included. Nine risk factors were assessed namely- age of the patient, duration of presentation after trauma, number of ribs fractured, bilateral thoracic injury, evidence of lung contusion, associated extra thoracic injury, need for mechanical ventilation, Revised trauma Score (RTS) and Modified Early Warning Sign Score (MEWS). Severity of blunt thoracic trauma was assessed on following outcomes-SIRS, ARDS and Death. The inferences were drawn with the use of statistical software package SPSS v22.0. </br> <b>Results:</b> The age of 50 patients included in our study with a range of 15 to 76 years, the median age was 35.5 years. Statistically significant association was observed between occurrence of SIRS and multiple ribs fractured (p-value- 0.049), associated extra-thoracic injury (p-value-0.016) and higher MEWS score (p-value-0.025). ARDS occurrence was statistically significantly associated with all the risk factors except age.Death occurred more in patients with delayed duration of presentation to hospital (p-value <0.001), multiple ribs fractured (p-value-0.001), bilateral thoracic injury(p-value<0.001), associated extra-thoracic injury (p-value-0.004), patients who required ventilatory support (p-value<0.001), low RTS (p-value-0.006) and high MEWS (p-value-0.005) on admission. This association was found statistically significant. </br> <b>Conclusion:</b> High MEWS, associated extra-thoracic injuries and multiple rib fractured can very well predict poor outcome in terms of SIRS, ARDS and death. Aggressive treatment protocols should be established for better outcome in these patients with blunt trauma chest.

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

“…Ten studies demonstrated a higher risk of mortality in patients with three or more fractured ribs, when compared with patients with less than three rib fractures 6 7 13 33 38 40 45 47 70 71. Other studies reported an increasing risk of mortality with each additional rib fracture,2 34 39 43 66 72 four or more rib fractures,51 five or more rib fractures,20 35 55 six or more rib fractures,50 eight or more42 and multiple rib fractures (unspecified number) 53. Five studies found no association between number of rib fractures and increased risk of mortality 56 58 73–75…”

“…A number of studies demonstrated an increasing risk of mortality per additional year of age5 54–56 and others with an additional decade 2 14 57. In 14 studies age was not found to be a statistically significant risk factor for increased mortality,3 37 58–69 however it is worth noting that 4 of these studies used aged 45 years or more as the cut-off for increased risk 58 63 67 69…”

“…A number of other risk factors were investigated in either one or two studies and included time after injury,66 lateral rib fractures,20 vital capacity21 and predicted forced vital capacity,22 83 pulmonary contusion,39 73 surgical emphysema,68 early hyperoxaemia,84 lactate80 and base excess,16prehospital anticoagulants or antiplatelets,19 85 and alcohol use disorder75 (full results are reported in online supplemental file 3, table 8).…”