Prognostic factors in chest traumas: A prospective study of 500 patients

Article information

Abstract

Objective

Identify the factors of greatest impact in patients with chest trauma.

Patients and methods

A prospective study of 500 patients (425 men and 75 women) with chest trauma treated between January 2006 and December 2008. The parameters assessed include the degree of trauma, the abbreviated injury scale (AIS), the injury severity score (ISS), prehospital intubation, duration of mechanical ventilation, length of stay in the intensive care unit (ICU), number of rib fractures, presence of pulmonary contusion, haemothorax and cardio-pulmonary effects.

Results

The presence of polytrauma, the number of rib fractures, the presence of flail chest, pulmonary contusion, the delay in mechanical ventilation and age were shown to be effective markers of severity.

Conclusions

Thoracic injuries have a number of markers of severity. The mortality risk is associated with an ISS >25, the presence of 3 or more rib fractures with flail chest, pulmonary contusion, the development of ARDS, and with age >55.

Keywords:

Chest injuries

Blunt trauma

Rib fracture

Polytrauma

Resumen

Objetivo

Identificar los factores pronóstico de mayor impacto en el paciente con traumatismo torácico.

Método

Estudio prospectivo de 500 pacientes (425 hombres y 75 mujeres) con traumatismo torácico atendidos entre enero de 2006 y diciembre de 2008. Los parámetros valorados incluyen el grado del traumatismo, la abbreviate injury scale, el injury severity score, la intubación prehospitalaria, la duración de la ventilación mecánica, la estancia en unidad de cuidados intensivos, el número de fracturas costales, la presencia de contusión pulmonar, hemotórax y repercusión cardiopulmonar.

Resultados

La presencia de politraumatismo, el número de fracturas costales, la presencia de volet, la contusión pulmonar, el retraso en la ventilación mecánica y la edad se han demostrado marcadores eficaces de gravedad.

Conclusiones

Los traumatismos torácicos tienen una serie de indicadores de gravedad: el riesgo de mortalidad se asocia con un injury severity score > 25, la presencia de 3 o más fracturas costales con volet costal, contusión pulmonar, el desarrollo de ARDS y con una edad > 55 años.

Palabras clave:

Traumatismos torácicos

Traumatismo cerrado

Fractura costal

Politrauma

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References

[1.]

D.W. Ziegler, N.N. Agarwal.

The morbidity and mortality of rib fractures.

J Trauma, 37 (1994), pp. 975-979

Medline

[2.]

ATLS. Comité de Trauma del Colegio Americano de Cirujanos.

Programa avanzado de apoyo vital en trauma para médicos.

American College of Surgeons;, (1997),

[3.]

S.P. Baker, B. O’Neil, W. Haddon.

The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care.

J Trauma, 14 (1974), pp. 187-196

Medline

[4.]

R.J.A. Goris, T.P.A. Te Boekhorst, J.K.S. Nuytinck.

Multiple organ failure: Generalized autodestructive inflammation?.

Arch Surg, 120 (1985), pp. 1109-1115

Medline

[5.]

M. Herridge, A. Cheung, C. Tansey, A. Matte-Martyn, N. Díaz- Granados, F. Al-Saidi, et al.

One-year outcomes in survivors of the acute respiratory distress syndrome.

N Engl J Med, 348 (2003), pp. 683-693

http://dx.doi.org/10.1056/NEJMoa022450 | Medline

[6.]

A. Varela, P. Gámez, L. Madrigal.

Traumatismos torácicos.

Arch Bronconeumol, 36 (2000), pp. 15-20

Medline

[7.]

B.T. Flagel, F.A. Luchette, R.L. Reed, T.J. Espósito, K.A. Davis, J.M. Santaniello, et al.

Half-a-dozen ribs: The breakpoint for mortality.

Surgery, 138 (2005), pp. 717-723

http://dx.doi.org/10.1016/j.surg.2005.07.022 | Medline

[8.]

M. Sirmali, H. Türüt, S. Topçu, E. Gülhan, U. Yazici, S. Kaya, et al.

A comprehensive analysis of traumatic rib fractres: Morbidity, mortality and management.

Eur J Cardiothorac Surg, 24 (2003), pp. 133-138

Medline

[9.]

J. Freixinet, J. Beltrán, P.M. Rodríguez, G. Juliá, M. Hussein, R. Gil, et al.

Indicators of severity in ches trauma.

Arch Bronconeumol, 44 (2008), pp. 257-262

Medline

[10.]

S. Dissanaike, S. Shalhub, G.J. Jurkovich.

The evaluation of pneumomediastinum in blunt trauma patients.

J Trauma, 65 (2008), pp. 1340-1345

http://dx.doi.org/10.1097/TA.0b013e318169cd24 | Medline

[11.]

R. Ladurner, L.M. Qvick, F. Hohenbleicher, K.K. Hallfeldt, W. Mutschler, T. Mussak.

Pneumopericardium in blunt chest trauma after high speed motor vehicle accidents.

Am J Emerg Med, 23 (2005), pp. 83-86

Medline

[12.]

M. Kunisch-Hoppe, M. Hoppe, K. Rauber, C. Popella, W.S. Rau.

Traqueal rupture caused by blunt chest trauma: Radiological and clinical features.

Eur Radiol, 10 (2000), pp. 480-483

http://dx.doi.org/10.1007/s003300050080 | Medline

[13.]

A.A. Jabra, E.K. Fishman, B.M. Sheata, E.J. Perlman.

Localized persistent pulmonary and interstitial emphysema: CT findings with radiographic-pathologic correlation.

Am J Roentgenol, 169 (1997), pp. 1381-1384

[14.]

M.L. Ho, F.R. Gutiérrez.

Chest radiography in thoracic polytrauma.

AJR Am J Roentgenol, 192 (2009), pp. 599-612

http://dx.doi.org/10.2214/AJR.07.3324 | Medline

[15.]

R. Cooke, C. Shah, R. Gallop, S. Bellamy, M. Ancukiewicz, M. Eisner, et al.

A simple clinical predictive index for objective estimates of mortality in acute lung injury.

Crit Care Med, 37 (2009), pp. 1913-1920

http://dx.doi.org/10.1097/CCM.0b013e3181a009b4 | Medline

[16.]

M. Leone, F. Brégeon, F. Antonini, K. Chaumoitre, A. Charvet, L. Ban, et al.

Long-term outcome in chest trauma.

Anesthesiology, 109 (2008), pp. 864-871

http://dx.doi.org/10.1097/ALN.0b013e31818a4009 | Medline

[17.]

N. Habashi, P. Andrews.

Ventilator strategies for posttraumatic acute respiratory distress syndrome: Airway pressure release ventilation and the role of spontaneous breathing in critically ill patients.

Curr Opin Crit Care, 10 (2004), pp. 549-557

Medline

[18.]

R. Kallet, A. Campbell, R. Dicker, J. Katz, R. Mackersie.

Effects of tidal volume on work of breathing during lung protective ventilation in patients with acute lung injury and acute respiratory distress syndrome.

Crit Care Med, 34 (2006), pp. 8-14

Medline

[19.]

E. Seeley, D.F. McAuley, M. Eisner, M. Miletin, M.A. Matthay, R.H. Kallet.

Predictors of mortality in acute lung injury during the era of lung protective ventilation.

Thorax, 63 (2008), pp. 994-998

http://dx.doi.org/10.1136/thx.2007.093658 | Medline

[20.]

Y. Sakr, J.L. Vincent, K. Reinhart, J. Groeneveld, A. Michalopoulos, C. Sprung, et al.

High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury.

Chest, 128 (2005), pp. 3098-3108

http://dx.doi.org/10.1378/chest.128.5.3098 | Medline

[21.]

S. Erickson, G. Martin, J. Davis, M. Matthay, M. Eisner.

Recent trends in acute lung injury mortality: 1996-2005.

Crit Care Med, 37 (2009), pp. 1574-1579

http://dx.doi.org/10.1097/CCM.0b013e31819fefdf | Medline

[22.]

D.W. Spaite, E.A. Criss, T.D. Valenzuela, H.W. Meislin.

Prehospital advanced life support for major trauma: Critical need for clinical trials.

Ann Emerg Med, 32 (1998), pp. 480-489

Medline

[23.]

Z. Stockinger, N. McSwain.

Prehospital endotracheal intubation for trauma does not improve survival over bagvalve-mask ventilation.

J Trauma, 56 (2004), pp. 531-536

Medline

[24.]

S. Laudi, B. Donaubauer, T. Busch, T. Kerner, S. Bercker, H. Bail, et al.

Low incidence of multiple organ failure after major trauma.

Injury, 38 (2007), pp. 1052-1058

http://dx.doi.org/10.1016/j.injury.2007.03.020 | Medline

[25.]

A. Lavoie, L. Moore, N. LeSage, M. Liberman, J. Sampalis.

The injury severity score or the new injury severity score for predicting intensive care unit admission and hospital length of stay?.

Injury, 36 (2005), pp. 477-483

http://dx.doi.org/10.1016/j.injury.2004.09.039 | Medline

[26.]

T. Osler, S.P. Baker, W. Long.

A modification of the injury severity score that both improves accuracy and simplifies scoring.

J Trauma, 43 (1997), pp. 922-926

Medline

[27.]

A. Lavoie, L. Moore, N. LeSage, J. Sampalis.

The new injury severity score: A more accurate predictor of in-hospital mortality than the injury severity score.

J Trauma, 56 (2004), pp. 1312-1320

Medline

[28.]

H. Tamim, A. Al Hazzouri, Z. Mahfoud, M. Atoui, S. El-Chemaly.

The injury severity score or the new injury severity score for predicting mortality, intensive care unit admission and length of hospital stay: Experience from a university hospital in a developing country.

Injury, 39 (2008), pp. 115-120

http://dx.doi.org/10.1016/j.injury.2007.06.007 | Medline

[29.]

E. Beale, J. Zhu, L. Chan, I. Shulman, R. Harwood, D. Demetriades.

Blood transfusion in critically injured patients: A prospective study.

Injury, 37 (2006), pp. 455-456

http://dx.doi.org/10.1016/j.injury.2005.12.008 | Medline

[30.]

B. Shaz, C. Dente, R. Harris, J. MacLeod, C. Hillyer.

Transfusion management of trauma patients.

Anesth Anal, 108 (2009), pp. 1760-1768