The Double Jeopardy of Blunt Thoracoabdominal Trauma

Berg, Regan J.; Okoye, Obi; Teixeira, Pedro G.R.; Inaba, Kenji; Δημητριάδης, Δημήτριος

doi:10.1001/archsurg.2011.2289

Cited by 27 publications

(29 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, these syndromes have become more relevant recently: with recent advances in clinical care, the outcome landscape in trauma has shifted from mortality to multiple organ dysfunction, nosocomial infection, and extended hospital and intensive care unit length of stay (25,110). Thus, in the current clinical setting, the clinical outcomes of trauma patients who do not achieve full recovery from the initial insult can progress to a state of persistent inflammation, immunosuppression, and catabolism syndrome (57).…”

Section: Diversity Of Immune Regulationmentioning

confidence: 99%

Insights into the Role of Chemokines, Damage-Associated Molecular Patterns, and Lymphocyte-Derived Mediators from Computational Models of Trauma-Induced Inflammation

Namas

et al. 2015

Antioxidants & Redox Signaling

View full text Add to dashboard Cite

Significance: Traumatic injury elicits a complex, dynamic, multidimensional inflammatory response that is intertwined with complications such as multiple organ dysfunction and nosocomial infection. The complex interplay between inflammation and physiology in critical illness remains a challenge for translational research, including the extrapolation to human disease from animal models. Recent Advances: Over the past decade, we and others have attempted to decipher the biocomplexity of inflammation in these settings of acute illness, using computational models to improve clinical translation. In silico modeling has been suggested as a computationally based framework for integrating data derived from basic biology experiments as well as preclinical and clinical studies. Critical Issues: Extensive studies in cells, mice, and human blunt trauma patients have led us to suggest (i) that while an adequate level of inflammation is required for healing post-trauma, inflammation can be harmful when it becomes self-sustaining via a damage-associated molecular pattern/Toll-like receptor-driven feed-forward circuit; (ii) that chemokines play a central regulatory role in driving either self-resolving or selfmaintaining inflammation that drives the early activation of both classical innate and more recently recognized lymphoid pathways; and (iii) the presence of multiple thresholds and feedback loops, which could significantly affect the propagation of inflammation across multiple body compartments. Future Directions: These insights from data-driven models into the primary drivers and interconnected networks of inflammation have been used to generate mechanistic computational models. Together, these models may be used to gain basic insights as well as serving to help define novel biomarkers and therapeutic targets. Antioxid. Redox Signal. 23, 1370-1387.Trauma: A Significant Burden T rauma/hemorrhagic shock remains the leading cause of death in patients younger than 45 years (70). It is the third leading cause of death worldwide, resulting in five million or 10% of all deaths annually and thus considered the fifth leading cause of significant disability (137). Traumatic injury is a pandemic disease, one that affects every nation in the world regardless of the level of socioeconomic development (70, 71).The disease is acute in onset, but often results in chronic, debilitating health problems that have effects beyond the individual victims. The financial impact of traumatic injuries is staggering: in 2000 in the United States, 10% of hospital discharges were due to injuries, and the direct cost of treating 50 million injury cases was $80.2 billion, with an estimated

show abstract

Section: Diversity Of Immune Regulationmentioning

confidence: 99%

Insights into the Role of Chemokines, Damage-Associated Molecular Patterns, and Lymphocyte-Derived Mediators from Computational Models of Trauma-Induced Inflammation

Namas

et al. 2015

Antioxidants & Redox Signaling

View full text Add to dashboard Cite

show abstract

“…Many present without vital signs and require resuscitative thoracotomy in the emergency department, which carries an extremely low rate (1-4 %) of recovery. In one study, age !55 years; ISS !25; GCS <8; hypotension; massive transfusion; and liver, cardiac, or abdominal vascular trauma were found to be independent risk factors for mortality from these injuries [103].…”

Section: Thoracoabdominal Traumamentioning

confidence: 90%

“…If surgery is contemplated, the abdomen is more likely to be the first cavity to be entered, as the vast majority of organ injuries occur in this cavity [103]. In the thorax, the lung is most commonly damaged, whereas in the abdomen, the spleen and the liver are usually involved.…”

Section: Thoracoabdominal Traumamentioning

confidence: 99%

“…Hollow viscus injuries are not common (2.6 %) and, if present, should be treated expeditiously. The overall mortality from these injuries is about 17-21 % [103]. This rate increases significantly with surgical exploration.…”

Section: Thoracoabdominal Traumamentioning

confidence: 99%

“…This rate increases significantly with surgical exploration. Nonoperative management, if possible, is associated with better survival [103].…”

Section: Thoracoabdominal Traumamentioning

confidence: 99%

See 2 more Smart Citations

Thoracic and Abdominal Injuries

Capan

Miller

2014

Anesthesia for Trauma

View full text Add to dashboard Cite

Injuries to the thorax and the abdomen-the torso-contribute significantly to trauma-related mortality and morbidity. While the vulnerability of the closely organized vital organs to injury in this region plays an important role in morbidity and mortality, the noncompressible nature of hemorrhage in this area also contributes immensely to otherwise preventable trauma deaths. While it is estimated that one fourth of trauma deaths is secondary to chest trauma alone and claims about 16,000 lives per year [1], hemorrhage in the torso (thorax, abdomen, and pelvis) also results in a mortality of as much as 70-80 % after otherwise survivable noncerebral and noncardiac injuries in both civilian and military populations [2]. The overall mortality from exsanguination, which remains second to central nervous system (CNS) injury as a cause of death, primarily originates from injuries of the thorax, abdomen, and pelvis; there has been a reduction in death from extremity bleeding because of effective control with tourniquets or topical hemostatic agents, but not from torso bleeding. With increasing use of anticoagulant agents for prophylaxis and management of cardio-and cerebrovascular disorders, bleedingrelated mortality from truncal injuries is probably more frequent. For example, the predominant injury site in patients with cardiovascular disease who died after trauma in one study was chest in 15 % and abdomen in 3 % of instances; head and neck was the injury site in 69 % of patients [3].In 2008, of the more than 42 million injuryrelated emergency room visits in the United States only 4 % were due to torso injuries; the corresponding percentages for upper extremity injuries, lower extremity injuries, head and neck injuries, and vertebral injuries were 18 %, 15 %, 14 %, and 5 %, respectively [4]. Other diagnoses such as poisoning, adverse effects, ill-defined conditions, and mental disorders made up the remaining injury-related emergency room admissions [4]. Thus, although torso injuries represent a relatively small percentage of the emergency room load, they appear to cause a greater proportion of morbidity and mortality than other injuries.Up to 80 % of thoracic injuries coexist with other injuries in major trauma patients, but they require major surgery and anesthesia relatively infrequently. Yet undetected, relatively minor thoracic injuries may result in life-threatening events during surgery for associated injuries or intensive care management of the multiple trauma patient. Pneumothorax and hemothorax are perfect examples of this clinical situation. On the other hand, because of their sometimes silent nature, even major thoracic injuries (e.g., esophageal, diaphragmatic, and airway trauma) may be missed if appropriate diagnostic

show abstract