Risk Factors for Empyema After Diaphragmatic Injury: Results of a National Trauma Databank Analysis

Barmparas, Galinos; DuBose, Joseph J.; Teixeira, Pedro G.R.; Recinos, Gustavo; Inaba, Kenji; Plurad, David; Green, D J.; Δημητριάδης, Δημήτριος

doi:10.1097/ta.0b013e318185e20e

Cited by 10 publications

(17 citation statements)

References 14 publications

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“…The NTDB is the largest available source of trauma registry data in the United States. [15][16][17] We used the dataset collected and compiled in 2012, as this is both the largest and most recent dataset available currently. It contains 833,309 individual patient records that have been subjected to a quality screening for consistency and validity.…”

Section: Methodsmentioning

confidence: 99%

Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis

Fair

Gordon

Barbosa

et al. 2015

The American Journal of Surgery

135

118

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Section: Methodsmentioning

confidence: 99%

Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis

Fair

Gordon

Barbosa

et al. 2015

The American Journal of Surgery

135

118

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“…Barmparas et al, performed a retrospective analysis using the National Trauma Databank of risk factors of empyema after diaphragmatic injuries (2). They separated patients in 2 groups depending on the presentation of posttraumatic empyema.…”

Section: Discussionmentioning

confidence: 99%

“…This condition is present in most trauma patients with penetrating diaphragmatic injury. However, few studies have explored the factors that might contribute to posttraumatic empyema in the context of diaphragmatic injury (1,2). This type of trauma can be caused by both penetrating thoracoabdominal injuries or severe blunt trauma (3,4).…”

Section: Introductionmentioning

confidence: 99%

Risk factors of posttraumatic empyema in diaphragmatic injuries

García

Rodríguez

Sánchez

et al. 2022

Preprint

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Background: Penetrating diaphragmatic injuries are associated with a high incidence of posttraumatic empyema. We analyzed the contribution of trauma severity, specific organ injury, contamination severity, and surgical management to the risk of Posttraumatic empyema in patients who underwent surgical repair of diaphragmatic injuries at a level 1 trauma center.Methods: This is a retrospective review of the patients who survived more than 48 hours. Univariate OR calculations were performed to identify potential risk factors. Multiple logistic regression was used to calculate adjusted ORs and identify independent risk factors.Results: We included 192 patients treated from 2011 to 2020. There were 169 (88.0) male. The mean interquartile range, (IQR) of age was 27 (22 - 35) years. Gunshot injuries occurred in 155 subjects (80.7%). Mean (IQR) NISS and ATI were 29 (18 - 44) and 17 (10 - 27), respectively. Thoracic AIS was >3 in 38 patients (19.8%). Hollow viscus was injured in 105 cases (54.7%). Stomach in 65 (33.9%), colon in 52 (27.1%), small bowel in 42 (21.9%), and duodenum in 10 (5.2%). Visible contamination was found in 76 patients (39.6%).Potential thoracic contamination was managed with a chest tube in 128 cases (66.7%), with transdiaphragmatic pleural lavage in 42 (21.9%), and with Video Assisted Thoracoscopy Surgery or thoracotomy in 22 (11.5%). Empyema occurred in 11 patients (5.7%). Multiple Logistic Regression identified thoracic AIS >3 (OR 6.4, 95% CI 1.77 – 23. 43), and visible contamination (OR 5.13, 95% IC 1.26 – 20.90) as independent risk factors. The individual organ injured, or the method used to manage the thoracic contamination did not affect the risk of posttraumatic empyema.Conclusion: The severity of the thoracic injury and the presence of visible abdominal contamination were identified as independent risk factors of empyema after penetrating diaphragmatic trauma.

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“…[10] при эмпиеме плевры идентичность микрофлоры в дыхательных путях и плевральной полости была доказана только в 21% наблюдений, что подтвердило чаще нелегочную этиологию нагноения в плевральной полости. Накопленный обширный клинический материал позволил нам выявить достоверные факторы риска [5], проанализировавшими обширную базу данных по травме груди и живота с разрывом диафрагмы, были выявлены два независимых предиктора развития эмпиемы плеврытравма желудка и тяжесть повреждений более 20 баллов по шкале ISS. По нашим данным, повреждение полых органов желудочно-кишечного тракта достоверно увеличивало риск развития эмпиемы плевры при торакоабдоминальных ранениях, в то время как тяжесть травмы не повлияла на развитие этого осложнения.…”

Section: Discussionunclassified

“…По другим данным, наоборот, свернувшийся гемоторакс не оказался прогностическим фактором развития эмпиемы плевры [11]. К другим факторам риска относятся тяжесть повреждений, давность травмы, пожилой возраст пострадавшего, инфицирование плевральной поло-doi: 10.17116/hirurgia2015713-19 Факторы риска развития гнойных осложнений при повреждениях груди сти содержимым желудочно-кишечного тракта, многократное и длительное (более 6 сут) дренирование плевральной полости, ошибки, допущенные при хирургической обработке ран и дренировании плевральной полости [2,3,5,9,11].…”

Section: Introductionunclassified

Risk factors of suppurative complications in case of thoracic injury

ShN¹,

Mm²,

Ap³

et al. 2015

Khir. Z. im. N.I. Pirogova

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It was performed retrospective analysis of 463 cases of suppurative thoracic complications after injury (232) and closed thoracic trauma (231) for 20-year period. Incidence of purulent complications was 3.2% and 1.6% in case of injury and closed thoracic trauma respectively including pleural empyema in 1.5 and 1.3%, pulmonary abscess in 0.3 and 0.4%, mediastinitis in 0.35 and 0.12%, pericarditis in 1.5 and 0.26%, osteomyelitis in 0.4 and 0.18% respectively. Factors preceding suppurative complications in case of injuries and closed trauma have been considered as predictors. Multivariant regression analysis established significant risk factors of suppurative thoracic complications. Clotted hemothorax, mediastinal hemorrhage, heart injury, late appeal for medical assistance and mechanical ventilation over 5 days were identified irrespective of character of trauma. In case of thoracic injury there were damage of osteochondrous frame, hollow thoracic and abdominal organs, gunshot wound of lung, delirium and injuries severity over 20 scores according to ISS scale. Pulmonary bleeding, sternal fracture and Glasgow Coma Scale rate<12 scores were identified as risk factors in case of closed trauma.

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Risk Factors for Empyema After Diaphragmatic Injury: Results of a National Trauma Databank Analysis

Abstract: Empyema is an uncommon sequela of diaphragm injury that contributes to the need for prolonged hospital and ICU LOSs. Associated gastric trauma and Injury Severity Score > or = 20 were independently associated with empyema development after diaphragmatic injury.

Cited by 10 publications

References 14 publications

Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis

Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis

Risk factors of posttraumatic empyema in diaphragmatic injuries

Risk factors of suppurative complications in case of thoracic injury

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