Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients

Abstract

Background and purposeThoracic trauma remains to be a relevant injury to the polytraumatised patient. However, literature regarding how far changes in clinical guidelines for pre- and in-hospital trauma management and diagnostic procedures affect the outcome of multiple injured patients with severe chest injury during a long-term observation period is sparse.MethodsMultiple traumatised patients (age≥16y) documented in the TraumaRegister DGU® (TR-DGU) from January 1st 2005 to December 31st 2014 with severe chest trauma (AIS≥3) were included in this study. Demographic data, the pattern of injury, injury severity, radiographic emergency procedures, indication for intubation, duration of mechanical ventilation, emergency surgery, occurrence of complications and mortality were evaluated per year and over time.ResultsA total of 16,773 patients were analysed. The use of whole body computer tomography increased (p<0.001), while the incidence of plain x-rays decreased (p<0.001). Furthermore, incidence of AISThorax = 3 graded injuries increased (p<0.001) while AISThorax = 4 decreased (p<0.001). Both, rate of patients being intubated at the time of ICU admission decreased (p<0.001) and the time of mechanical ventilation decreased (p<0.001). Additionally, need for emergency surgery, lung failure, sepsis, and multi organ failure all decreased (p<0.001). However, mortality remained unchanged.InterpretationSeverity of severe chest trauma and associated complications decreased while diagnostics and treatment improved over time. However, mortality remained unchanged. Our results are in line with those expected in the context of the incidence of CT diagnostics, which has increased parallel to the clinical outcome Thus, our data demonstrate a positive trend in the treatment of patients with severe chest trauma.

Ageing population has changed the nature of major thoracic injury

“…Increases in the incidence of thoracic injuries have been reported in prior studies, and were purported to be due to the increased use of CT 24. Chest radiography, previously the mainstay investigation, has a low sensitivity for thoracic injuries25 and the more widespread use of CT among the trauma population could have resulted in an increased rate of detection of previously missed or underestimated injuries 24…”

“…Chest radiography, previously the mainstay investigation, has a low sensitivity for thoracic injuries25 and the more widespread use of CT among the trauma population could have resulted in an increased rate of detection of previously missed or underestimated injuries 24…”

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.…”

“…This may be due to the emergent treatment of hemothorax with surgery or chest tube drainage, and because patients with flail chest often undergo surgical stabilization in the early period. A large study by Horst et al [19] included over 10 years of experience regarding patients with serious thoracic trauma. In that study, over those 10 years, there was a decrease in the requirement of those patients for urgent surgery, as well as in ventilation time, ICU stay length, and rate of respiratory failure development.…”

On dynamic behavior of bone: Experimental and numerical study of porcine ribs subjected to impact loads in dynamic three-point bending tests

“…Burnside and McManus (2014) had presented a detailed summary on injury mechanisms and the severity of injury for BTT. Moreover, it is proved that RTA's are the principal cause for BTT and can be seen in Liman et al (2003), Shirley (2005) and Horst et al (2017). In fact, these mechanisms play an important role in the prediction of injury severity prior to radiological examination.…”