Factors related to clinical outcomes in blunt thoracic injuries

Degirmenci, Mehmet

doi:10.1007/s11748-022-01796-5

Cited by 3 publications

(7 citation statements)

References 26 publications

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“…Ten studies demonstrated a higher risk of mortality in patients with three or more fractured ribs, when compared with patients with less than three rib fractures 6 7 13 33 38 40 45 47 70 71. Other studies reported an increasing risk of mortality with each additional rib fracture,2 34 39 43 66 72 four or more rib fractures,51 five or more rib fractures,20 35 55 six or more rib fractures,50 eight or more42 and multiple rib fractures (unspecified number) 53. Five studies found no association between number of rib fractures and increased risk of mortality 56 58 73–75…”

Section: Resultsmentioning

confidence: 99%

“…There were 50 studies of varying design and quality which investigated whether age was a risk factor for mortality in patients with blunt chest wall trauma (online supplemental file 3, table 1). Of these, 19 studies demonstrated a higher risk of mortality in patients aged 65 years or more when compared with patients aged less than 65 years 7 13–16 30–43. Other studies demonstrated that increased risk of mortality occurred in patients aged 50 years or more,17 55 years or more,44 45 60 years or more,46–50 70 years or more,51 80 years or more,52 and 90 years or more 53.…”

Section: Resultsmentioning

confidence: 99%

“…Pre-existing conditions were also reported to be a risk factor as measured by the Elixhauser Comorbidity Count,5 and Charlson Comorbidity Score 14 78. One study reported comorbidities as a significant risk factor for death, but without defining comorbidities 35…”

Section: Resultsmentioning

confidence: 99%

“…In patients with flail chest, conflicting results were reported, with a number of studies reporting ISS as a significant risk factor2 57 60 and others reporting no significance 39 59. A higher New Injury Severity Score was reported to be a significant risk factor for mortality in three studies 35 54 80. Pooled data (as meta-analysis is not possible) for increasing ISS and a corresponding forest plot is included in online supplemental file 4, figure 3.…”

Section: Resultsmentioning

confidence: 99%

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Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

et al. 2022

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BackgroundOver the last 10 years, research has highlighted emerging potential risk factors for poor outcomes following blunt chest wall trauma. The aim was to update a previous systematic review and meta-analysis of the risk factors for mortality in blunt chest wall trauma patients.MethodsA systematic review of English and non-English articles using MEDLINE, Embase and Cochrane Library from January 2010 to March 2022 was completed. Broad search terms and inclusion criteria were used. All observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. Where sufficient data were available, ORs with 95% CIs were calculated using a Mantel-Haenszel method. Heterogeneity was assessed using the I2statistic.Results73 studies were identified which were of variable quality (including 29 from original review). Identified risk factors for mortality following blunt chest wall trauma were: age 65 years or more (OR: 2.11; 95% CI 1.85 to 2.41), three or more rib fractures (OR: 1.96; 95% CI 1.69 to 2.26) and presence of pre-existing disease (OR: 2.86; 95% CI 1.34 to 6.09). Other new risk factors identified were: increasing Injury Severity Score, need for mechanical ventilation, extremes of body mass index and smoking status. Meta-analysis was not possible for these variables due to insufficient studies and high levels of heterogeneity.ConclusionsThe results of this updated review suggest that despite a change in demographics of trauma patients and subsequent emerging evidence over the last 10 years, the main risk factors for mortality in patients sustaining blunt chest wall trauma remained largely unchanged. A number of new risk factors however have been reported that need consideration when updating current risk prediction models used in the ED.PROSPERO registration numberCRD42021242063. Date registered: 29 March 2021.https://www.crd.york.ac.uk/PROSPERO/%23recordDetails.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

et al. 2022

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“…Their study found that the presence of severe lung contusion and advanced age as independent risk factors directly related to mortality involving blunt chest trauma. Similarly, Degirmenci analyzed clinical outcomes in blunt thoracic injuries and concluded that injury severity, associated organ injuries, and pleural and pulmonary parenchymal injuries are the factors most associated with poor clinical outcomes [ 25 ]. Furthermore, Battle et al concluded that an age of 65 years or more, three or more rib fractures, pre-existing cardiopulmonary disease, and post-injury pneumonia were significant risk factors for mortality in patients with blunt chest wall trauma [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Major Risk Factors for Mortality in Elderly and Non-Elderly Adult Patients Emergently Admitted for Blunt Chest Wall Trauma: Hospital Length of Stay as an Independent Predictor

Elgar

Smiley

Latifi

2022

IJERPH

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Background: Blunt thoracic trauma is responsible for 35% of trauma-related deaths in the United States and significantly contributes to morbidity and healthcare-related financial strain. The goal of this study was to evaluate factors influencing mortality in patients emergently admitted with the primary diagnosis of blunt chest wall trauma. Methods: Adults emergently admitted for blunt chest trauma were assessed using the National Inpatient Sample Database, 2004–2014. Data regarding demographics, comorbidities, and outcomes were collected. Relationships were determined using univariable and multivariable logistic regression models. Results: In total, 1120 adult and 1038 elderly patients emergently admitted with blunt chest trauma were assessed; 46.3% were female, and 53.6% were male. The average ages of adult and elderly patients were 46.6 and 78.9 years, respectively. Elderly and adult patients both displayed mortality rates of 1%. The regression model showed HLOS and several comorbidities as the main risk factors of mortality Every additional day of hospitalization increased the odds of mortality by 9% (OR = 1.09, 95% CI = 1.01–1.18, p = 0.033). Mortality and liver disease were significantly associated (OR = 8.36, 95% CI = 2.23–31.37, p = 0.002). Respiratory disease and mortality rates demonstrated robust correlations (OR = 7.46, 95% CI = 1.63–34.11, p = 0.010). Trauma, burns, and poisons were associated with increased mortality (OR = 3.72, 95% CI = 1.18–11.71, p = 0.025). The presence of platelet/white blood cell disease correlated to higher mortality. (OR = 4.42, 95% CI = 1.09–17.91, p = 0.038).

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Health care utilization outcomes in patients with blunt chest wall trauma following discharge from the emergency department: A retrospective, observational data-linkage study

Battle¹,

Hutchings²,

Rafferty³

et al. 2023

J Trauma Acute Care Surg

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Background Whilst much is published reporting clinical outcomes in the patients with blunt chest wall trauma who are admitted to hospital from the ED, less is known about the patients’ recovery when they are discharged directly without admission. The aim of this study was to investigate the healthcare utilisation outcomes in adult patients with blunt chest wall trauma, discharged directly from ED in a trauma unit in the UK. Methods This was a longitudinal, retrospective, single-centre, observational study incorporating analysis of linked datasets, using the Secure Anonymised Information Linkage (SAIL) databank for admissions to a trauma unit in the Wales, between 1st January 2016 and 31st December 2020. All patients aged ≥16 years with a primary diagnosis of blunt chest wall trauma discharged directly home were included. Data was analysed using a negative binomial regression model. Results 3205 presentations to the ED were included. Mean age was 53 years, 57% were male, with the predominant injury mechanism being a low velocity fall (50%). 93% of the cohort sustained between 0-3 rib fractures. 4% of the cohort were reported to have COPD, and 4% using pre-injury anticoagulants. On regression analysis, inpatient admissions, outpatient appointments and primary care contacts all significantly increased in the 12-week period post-injury, compared with the 12-week period pre-injury (OR: 1.63 95% CI: 1.33-1.99, p < 0.001; OR: 1.28, 95% CI: 1.14-1.43, p < 0.001; OR: 1.02. 95% CI: 1.01-1.02, p < 0.001 respectively). Risk of healthcare resource utilisation increased significantly with each additional year of age, COPD and pre-injury anti-coagulant use (all p < 0.05). Social deprivation and number of rib fracture did not impact outcomes. Conclusion The results of this study demonstrate the need for appropriate signposting and follow-up for patients with blunt chest wall trauma presenting to the ED, not requiring admission to the hospital. Study type and level of evidence Prognostic / epidemiological. Level IV

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Factors related to clinical outcomes in blunt thoracic injuries

Cited by 3 publications

References 26 publications

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

Major Risk Factors for Mortality in Elderly and Non-Elderly Adult Patients Emergently Admitted for Blunt Chest Wall Trauma: Hospital Length of Stay as an Independent Predictor

Health care utilization outcomes in patients with blunt chest wall trauma following discharge from the emergency department: A retrospective, observational data-linkage study

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