Factors Associated with ICU Admission following Blunt Chest Trauma

Abstract

Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF) and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1%) were admitted to intensive care unit (ICU) within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p = 0.0018) and the severity of trauma score (p < 0.0002) were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure.

Predictors Of Mortality In Cases With Thoracic Trauma Admitted To The Intensive Care Unit: 10-Year Clinical Outcomes

“…The median age of the patients included in this study was 43 (min-max 18-87) years, which was consistent with the literature, and the majority of the patients were male. [14][15][16][17][18][19][20] Previous reports have shown that mortality rates in patients with thoracic trauma are markedly high (up to 30%). [21] Emircan et al [22] reported a 22% mortality rate among patients presenting to the emergency department with thoracic trauma.…”

“…[29] TRISS combines both anatomical and physiological aspects, and has been proven to be a good predictor of survival in patients with trauma. In a study that retrospectively evaluated 140 patients with thoracic trauma, Bellone et al [16] reported that only 10 of those 140 patients (7.1%) were admitted to the ICU due to clinical and radiological deterioration. In univariate and multivariate analyses, the authors of that study found that increasing orthopnea and trauma scores could be used to predict intensive care requirement.…”

Der Patient mit Thoraxtrauma: präklinische Versorgung

“…Traumapatient, der in eine Notaufnahme eingewiesen wurde, ein stumpfes Thoraxtrauma erlitten. In der Literatur wird eine Mortalität zwischen 4 und 20 % für diese Patienten angegeben [10].…”

The clinical effectiveness of the STUMBL score for the management of ED patients with blunt chest trauma compared to clinical evaluation alone

“…Blunt chest trauma accounts for around 15% of all Emergency Department (ED) trauma presentations worldwide with significant morbidity and mortality [1][2][3][4]. Currently, no evidence-based guidelines exist to assist in the management of this patient group unless the patient has severe, immediate life-threatening injuries [1,[4][5][6].…”

“…Currently, no evidence-based guidelines exist to assist in the management of this patient group unless the patient has severe, immediate life-threatening injuries [1,[4][5][6]. Decisions around the ongoing management of non-life-threatening blunt chest wall trauma patients in the ED is difficult due to the frequent onset of delayed respiratory complications and clinical symptoms in the ED are not considered an accurate predictor of outcome [1,2,[6][7][8][9].…”