Studying morbidity and predicting mortality in patients with blunt chest trauma using a novel clinical score

Manay, Priyadarshini; Satoskar, Rajeev R; Karthik, V; Prajapati, Ram P

doi:10.4103/jets.jets_131_16

Cited by 18 publications

(9 citation statements)

References 21 publications

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“…A review of literature has conveyed that morbidity and mortality rates increase relative to the location, number, and the presence of bilateral rib fractures, this being compounded by the development of haemothorax/pneumothorax or secondary pulmonary sequalae. The outcome of a clinical audit conducted by Manay et al concluded that the mortality rate in patients with missed chest injuries was 15.1% compared with 7.6% of patients who had their injuries diagnosed in the acute setting …”

Section: Discussionmentioning

confidence: 99%

Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study

Napier

2019

Sonography

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Rib fracture is reported to be the most commonly encountered aetiology following blunt chest trauma, 1,2 but despite this, it is frequently regarded as insignificant. Unfortunately, this ideology is compounded when the limitations of conventional imaging modalities are evaluated. In the acute setting, plain radiography can render rib fractures undetected in 50% of cases, 3 and although computer tomography (CT) is deemed to have a higher sensitivity than plain film, its limitations can include a lower specificity in the setting of higher radiation doses. 4,5 Regarded as being a sentinel injury, a rib fracture can act as an external marker to more serious pathologies 5-7 which can in turn compromise the normal breathing mechanism and/or the status of the thoraco-abdominal organs. As delayed diagnosis can result in increased patient morbidity and mortality, resulting from both primary and secondary complications, the detection of rib fracture is imperative in not only predicting patient outcomes but in the development of appropriate management pathways. 2,8 The aim of this case study is therefore twofold-it evaluates the sequelae that can result from rib fracture irrespective of how trivial the injury may seemand in doing so acknowledges the importance of correctly identifying this pathology in the acute setting. Secondly, it highlights a case where ultrasound detected rib fractures not seen on original plain radiographs, but suspected on magnetic resonance imaging (MRI) in a setting where CT of the chest was not performed. | CASE DESCRIPTIONA 37-year-old female presented to the emergency department following a high-speed motor vehicle accident (MVA) in which she was the front seat passenger. Suspicion was raised as to the presence of a retro-peritoneal bleed or hollow organ perforation upon sighting extensive thoraco-abdominal swelling and haematoma in conjunction with a tachycardic heart rhythm of 110 to 130 beats per minute. The initial chest radiograph was deemed unremarkable with normal cardio-mediastinal contours and clear lung fields. No evidence of pneumothorax or displaced rib injury was detected despite the patient complaining of slight chest discomfort on inspiration.As this woman was of child-bearing age and a radiation worker, doctors were hesitant to perform a CT scan initially, and as such intravenous fluids were hung and a period of observation undertaken in the hope that the tachycardia would subside. An ECG eight hours post MVA continued to demonstrate a tachycardic rhythm, and so it was decided to perform an abdominal ultrasound to exclude any intraperitoneal bleeding. No free fluid or solid organ lacerations were detected on the ultrasound scan. As mesenteric shearing could not be excluded by ultrasound, a CT was requested of the abdomen and pelvis. The results were again unremarkable, and the patient was observed overnight in case any pathology developed in the critical hours post trauma. Nine hours later, the patient's heart rate had dropped below 100 beats per minute, her chest sounds were cle...

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Section: Discussionmentioning

confidence: 99%

Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study

Napier

2019

Sonography

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“…Manay et al, after evaluating patients with BCT, found that when the number of RF was !4 there was a statistically significant increase in mortality. 30 They also found that presence of head injury and GCS 8 was associated with an increase in mortality in BCT patients. In our study, the mortality in both the ET and LT groups was mainly due to TBI; however, all these subjects also had !5 fractured ribs.…”

Section: Variablementioning

confidence: 94%

Early Versus Late Tracheostomy in Trauma Patients With Rib Fractures

Fokin

Wycech

Shue

et al. 2020

Journal of Surgical Research

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“…However, the best analgesic technique in thoracic trauma is unclear. Manay et al [37] reported that Thoracic Epidural Analgesia (TEA) halved the number of days that the patients were intubated and significantly decreased the incidence of pneumonia. In a multicenter cohort study, Gage et al [38] concluded that TEA reduced mortality in patients with three or more rib fractures.…”

Section: The Paradigm Of Pain In Thoracic Traumamentioning

confidence: 99%

Pain is vital in resuscitation in trauma

Saranteas

Kostroglou

Anagnostopoulos

et al. 2019

SICOT-J

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Implementation of the ATLS algorithm has remarkably improved the resuscitation of trauma patients and has significantly contributed to the systematic management of multi-trauma patients. However, pain remains the most prevalent complaint in trauma patients, and can induce severe complications, further deterioration of health, and death of the patient. Providing appropriate and timely pain management to these patients prompts early healing, reduces stress response, shortens hospital Length of Stay (LOS), diminishes chronic pain, and ultimately reduces morbidity and mortality. Pain has been proposed to be evaluated as the fifth vital sign and be recorded in the vital sign charts in order to emphasize the importance of pain on short- and long-term outcomes of the patients. However, although the quality of pain treatment seems to be improving we believe that pain has been underestimated in trauma. This article aims to provide evidence for the importance of pain in trauma, to support its management in the emergency setting and the acute phase of patients’ resuscitation, and to emphasize on the necessity to introduce the letter P (pain) in the ATLS alphabet.

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Studying morbidity and predicting mortality in patients with blunt chest trauma using a novel clinical score

Cited by 18 publications

References 21 publications

Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study

Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study

Early Versus Late Tracheostomy in Trauma Patients With Rib Fractures

Pain is vital in resuscitation in trauma

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