Mechanism of injury, injury patterns and associated injuries in patients operated for chest wall trauma

Caragounis, Eva-Corina; Xiao, Yao; Granhed, Hans

doi:10.1007/s00068-019-01119-z

Cited by 19 publications

(18 citation statements)

References 34 publications

(48 reference statements)

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“…Head trauma has been reported in the present study as the most frequent 34.8% extra-thoracic injury. Many research, however, recorded MSK injury as the most prevalent extrathoracic injury 50% [3,[13][14][15], whereas in the current study it was the third most common 15.3% and the second common was abdominal injury 17.4%.…”

Section: Discussioncontrasting

confidence: 63%

Extensive Epidemiological Study of Traumatic Pneumothorax in Saudi Arabia’s Population

Alrashidi

2021

Asian J Pharm Clin Res

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Objectives: Traumatic pneumothorax is one of the causes of trauma mortality and morbidity. It is a problem for developing countries as many accidents can be avoided and there are few epidemiological data to support programs injury prevention. The main objective of the current study was to determine demographic characteristics, patterns, and severity of the injury, thoracic, and extra-thoracic related injuries in a Level 1 trauma center, Riyadh, Saudi Arabia (SA). Methods: This retrospective observational study used the King Abdulaziz Medical City Trauma Center’s trauma registry to review the data of traumatic pneumothorax patients admitted to the hospital from January 2001 to December 2018. Demographic characteristics, admission date and time, type and mechanism of injury, involved body area, and severity rates were analyzed. Results: A total of 708 patients of whom 92.3% were males. Blunt trauma (75.8%) is the most common cause of injury. Motor Vehicle Accidents (MVA) were the most common cause (57%) of traumatic pneumothorax. Rib fractures (36.5%), lung contusions (31.5%), and hemothorax (23.5%) were the most common clinical forms of chest injury associated with traumatic pneumothorax. On the other hand, the head injury (34.8%) was the most common extra thoracic part associated. The mean Injury Severity Score in the current study was found to be 20.1. Conclusion: This study showed the trends of traumatic pneumothorax injuries in a Level 1 trauma center, Riyadh, SA, showing MVA are the leading cause of traumatic pneumothorax in our region. These demographic data will be crucial for local health-care systems to be optimally resourced.

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Section: Discussioncontrasting

confidence: 63%

Extensive Epidemiological Study of Traumatic Pneumothorax in Saudi Arabia’s Population

Alrashidi

2021

Asian J Pharm Clin Res

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“…A trauma surgeon should focus on anatomy, pathology, the patient's physiology and rearrangement of impaired physiology [ 19 ]. Using rib fractures as an example, injuries to at least three body regions were found in as many as 60% of patients with rib fractures [ 20 ], and solid organ injuries below the diaphragm are very common concomitant findings in these patients [ 21 ]. Therefore, treatment for these patients requires attention to intra-thoracic complications and diagnosis and the management of extra-thoracic injuries.…”

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: The role of acute care surgeons in treating rib fractures—a retrospective cohort study from a single level I trauma center

et al. 2022

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Background Rib fractures are the most common thoracic injury in patients who sustained blunt trauma, and potentially life-threatening associated injuries are prevalent. Multi-disciplinary work-up is crucial to achieving a comprehensive understanding of these patients. The present study demonstrated the experience of an acute care surgery (ACS) model for rib fracture management from a single level I trauma center over 13 years. Methods Data from patients diagnosed with acute rib fractures from January 2008 to December 2020 were collected from the trauma registry of Chang Gung Memorial Hospital (CGMH). Information, including patient age, sex, injury mechanism, Abbreviated Injury Scale (AIS) in different anatomic regions, injury severity score (ISS), index admission department, intensive care unit (ICU) length of stay (LOS), total admission LOS, mortality, and other characteristics of multiple rib fracture, were analyzed. Patients who received surgical stabilization of rib fractures (SSRF) were analyzed separately, and basic demographics and clinical outcomes were compared between acute care and thoracic surgeons. Results A total of 5103 patients diagnosed with acute rib fracture were admitted via the emergency department (ED) of CGMH in the 13-year study period. The Department of Trauma and Emergency Surgery (TR) received the most patients (70.8%), and the Department of Cardiovascular and Thoracic Surgery (CTS) received only 3.1% of the total patients. SSRF was initiated in 2017, and TR performed fixation for 141 patients, while CTS operated for 16 patients. The basic demographics were similar between the two groups, and no significant differences were noted in the outcomes, including LOS, LCU LOS, length of indwelling chest tube, or complications. There was only one mortality in all SSRF patients, and the patient was from the CTS group. Conclusions Acute care surgeons provided good-quality care to rib fracture patients, whether SSRF or non-SSRF. Acute care surgeons also safely performed SSRF. Therefore, we propose that the ACS model may be an option for rib fracture management, depending on the deployment of staff in each institute.

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“…Third, rib fractures are associated with high morbidity, mortality and are indicators for concomitant organ injury [21,33]. While it is known that specific mechanisms of injury cause corresponding rib fracture patterns, to our knowledge, the link to chest-tube output and thoracotomy has not been studied [34]. Data of this study could not show evidence for rib fracture patterns that are associated with high chest-tube output or urgent thoracotomy-nor was there a correlation to rib plating.…”

Section: Discussionmentioning

confidence: 55%

Blunt Chest Trauma in Polytraumatized Patients: Predictive Factors for Urgent Thoracotomy

Stolberg-Stolberg

Katthagen

Hillemeyer

et al. 2021

JCM

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Purpose: Current guidelines on urgent thoracotomy of polytraumatized patients are based on data from perforating chest injuries. We aimed to identify predictive factors for urgent thoracotomy after chest-tube placement for blunt chest trauma in a civilian setting. Methods: Polytraumatized patients (Injury Severity Score ≥16) with blunt chest trauma, submitted to a level I trauma centre during a period of 12 years that received at least one chest tube were included. Trauma mechanism, chest-tube output, haemoglobin values, need for cellular blood products, coagulopathies, rib fracture pattern, thoracotomy, and mortality were retrospectively analysed. Results: 235 polytraumatized patients were included. Patients that received urgent thoracotomy (UT, n = 10) showed a higher mean chest-tube output within 24 h with a median (Mdn) of 3865 (IQR 2423–5156) mL compared to the group with no additional thoracic surgery (NT, n = 225) with Mdn 185 (IQR 50–463) mL (p < 0.001). The cut-off 24-h chest-tube output value for recommended thoracotomy was 1270 mL (ROC-Curve). UT showed an initial haemoglobin of Mdn 11.7 (IQR 9.2–14.3) g/dL and an INR value of Mdn 1.27 (IQR 1.11–1.69) as opposed to Mdn 12.3 (IQR 10–13.9) g/dL and Mdn 1.13 (IQR 1.05–1.34) in NT (haemoglobin: p = 0.786; INR: p = 0.215). There was an average number of 7.1(±3.4) rib fractures in UT and 6.7(±4.8) in NT (p = 0.649). Conclusions: Chest-tube output remains the single most important predictive factor for urgent thoracotomy also after blunt chest trauma. Patients with a chest-tube output of more than 1300 mL within 24 h after trauma should be considered for transfer to a level I trauma centre with standby thoracic surgery.

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Mechanism of injury, injury patterns and associated injuries in patients operated for chest wall trauma

Cited by 19 publications

References 34 publications

Extensive Epidemiological Study of Traumatic Pneumothorax in Saudi Arabia’s Population

Extensive Epidemiological Study of Traumatic Pneumothorax in Saudi Arabia’s Population

RETRACTED ARTICLE: The role of acute care surgeons in treating rib fractures—a retrospective cohort study from a single level I trauma center

Blunt Chest Trauma in Polytraumatized Patients: Predictive Factors for Urgent Thoracotomy

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