Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients—still a relevant problem?

Abstract

BackgroundThoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients’ mortality.MethodsIn this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014. Data collection included details of treatment and outcome. Patients with chest trauma and Injury Severity Score (ISS) ≥18 and Abbreviated Injury Scale (AIS) >2 in more than one body region were included.ResultsA total of 110 polytrauma patients with blunt chest injury were evaluated. 82 of them were males and median age was 48.5 years. Car accidents, falls from a height and motorbike accidents were the most common causes (>75%) for blunt chest trauma. Rib fractures, pneumothorax and pulmonary contusion were the most common chest injuries. Most patients (64.5%) sustained a serious chest injury (AISthorax 3), 19.1% a severe chest injury (AISthorax 4) and 15.5% a moderate chest injury (AISthorax 2). 90% of patients with blunt chest trauma were treated conservatively. Chest tube insertion was indicated in 54.5% of patients. The need for chest tube was significantly higher among the AISthorax 4 group in comparison to the AIS groups 3 and 2 (p < 0.001). Also, admission to the ICU was directly related to the severity of the AISthorax (p < 0.001). The severity of chest trauma did not correlate with ICU length of stay, intubation days, complications or mortality.ConclusionAlthough 84.5% of patients suffered from serious or even severe chest injury, neither in the conservative nor in the surgically treated group a significant impact of injury severity on ICU stay, intubation days, complications or mortality was observed. AISthorax was only related to the rate of chest tube insertions and ICU admission. Management with early chest tube insertion when necessary, pain control and chest physiotherapy resulted in good outcome in the majority of patients.

A pathology not be overlooked in blunt chest trauma: Analysis of 181 patients with bilateral pneumothorax

“…Common associated injuries include spine injuries, extremity fractures, abdominal injuries, and head trauma. [17] In the study conducted by Chrysou et al, [8] the most common co-existing extra-thoracic injuries were extremity fractures, spine injuries, and head trauma, with an incidence rate of 76.4%, 53.6%, and 37.3%, respectively. Freixinet et al [12] reported a rate of 19.1% for extra-thoracic trauma, and mentioned that limb fracture was the most common pathology, with an incidence of 28.7%.…”

“…[7] The incidence of rib fracture in all trauma cases varies in the range of 10% to 40%. [1,4] Chrysou et al [8] reported that rib fractures comprised the largest group of thoracic injuries, with a rate of 86.4%. The incidence of bilateral rib fractures has been reported to be 22.7%.…”

“…Charbit et al [3] reported that 47.0% of patients with PTx after BCT were intubated and followed up with MV. Chrysou et al [8] reported that intubation and MV had been necessary for 29.1% (32 in 110 patients) of polytrauma patients with BCT. In our study, the incidence rate of intubation and MV was 37.6%.…”

Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure

“…Other studies have usually targeted treatments of severe blunt chest trauma by managing the hemothorax or pneumothorax [21][22][23]. Initially, fractured ribs were not the main target of treatment in our hospital [23].…”

Liver injury secondary to chest tube placement: a case report of conservative management and review of literature

“…It can concern traumatic situation , malignant effusion , or postoperative management . In the emergency department, more than 50% of patients presenting a thoracic injury require a thoracostomy . Complications can occur during the procedure or during chest tube maintenance with a range from 5% to 10% and may concern lung, heart, intercostal pedicle, diaphragm, spleen, and bowel and the list is not exhaustive .…”