Evaluation of risk factors for prognosticating blunt trauma chest (original) (raw)
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Background: Chest trauma is a significant cause of mortality and morbidity, especially in the younger population. Injuries to the thorax are the third most common injuries in trauma patients, next to injuries to the head and extremities. Outcome and prognosis for the vast majority of patients with chest trauma are excellent. There are many predictors of mortality in chest trauma patients. However, the present standards for assessing thoracic trauma vary widely. For this in 2000 Pape et al. developed the Thoracic Trauma Severity Score (TTSS), which combines the patient's age, resuscitation parameters, and radiological assessment of the thorax. The aim of this study: was to assess the validity if any of the Thorax Trauma Severity Score and its ability to predict mortality in blunt chest trauma patients. Methodology: It was a cross-sectional study included 30 patients. Results: It (TTSS) was found to be a good predictor of mortality among the studied patients on initial evaluation, with a score larger than 7. The score is 100% sensitive and 100% specific for prediction of poor outcome (Death and ICU admission) versus good outcome (Discharge from ER and inpatient admission) with 100% positive predictive value and 100% negative predictive value. Conclusion: This study supports the use of the TTSS for predicting mortality in thoracic injury patients, as higher scores associated with higher mortality and morbidity.
Journal of emergencies, trauma, and shock
A departmental audit in March 2015 revealed significant mortality rate of 40% in blunt chest trauma patients (much greater than the global 25%). A study was thus planned to study morbidity and predictors of mortality in blunt chest trauma patients admitted to our hospital. This study was a prospective observational study of 139 patients with a history of blunt chest trauma between June 2015 and November 2015 after the Institutional Ethics Committee approval in April 2015. The sample size was calculated from the prevalence rate in our institute from the past medical records. The morbidity factors following blunt chest injuries apart from pain were need for Intensive Care Unit stay, mechanical ventilation, and pneumonia/acute respiratory distress syndrome. Significant predictors of mortality in our study were SpO2 <80 at the time of presentation, Glasgow coma scale ≤ 8, patients with four or more rib fractures, presence of associated head injury, Injury Severity Score >16, and n...
The Journal of Trauma: Injury, Infection, and Critical Care, 2000
Background: Current techniques for assessment of chest trauma rely on clinical diagnoses or scoring systems. However, there is no generally accepted standard for early judgement of the severity of these injuries, especially in regards to related complications. This drawback may have a significant impact on the management of skeletal injuries, which are frequently associated with chest trauma. However, no convincing conclusions can be determined until standardization of the degrees of chest trauma is achieved. We investigated the role of early clinical and radiologic assessment techniques on outcome in patients with blunt multiple trauma and thoracic injuries and developed a new scoring system for early evaluation of chest trauma.
Predictors of Outcome in Blunt Chest Trauma
Archivos de Bronconeumología ((English Edition)), 2004
INTRODUCTION: Thoracic trauma is often associated with polytrauma. Because mortality is high, the search for prognostic tools is useful. PATIENTS AND METHODS: A total of 108 patients with blunt thoracic trauma, 73 of whom had multiple injuries, were studied in an intensive care unit (ICU). The variables named as potential predictors of outcome were the need for mechanical ventilation, duration of ventilation, and high positive end-expiratory pressure (PEEP); the presence of rib fractures, pulmonary contusion, pleural involvement (hemoand/or pneumothorax), or lung infection; the need for emergency surgery; mean duration of ICU stay, and age. We also studied whether or not the mortality rate was higher in polytrauma patients. Student t and χ 2 tests (95% confidence level) and multiple regression analysis (Hosmer-Lemeshow goodness of fit) were used to analyze the results. RESULTS: The need for mechanical ventilation, radiographic evidence of pulmonary contusion, emergency surgery, and hemodynamic instability were risk factors for increased mortality. Higher risk of mortality was not demonstrated for patients with multiple injuries. For patients in need of mechanical ventilation, high PEEP was a predictor of poor prognosis. CONCLUSIONS: The presence of the aforementioned predictors (mechanical ventilation, high PEEP, pulmonary contusion, emergency surgery, and hemodynamic instability) indicate serious injury to the lung parenchyma, which is the main determinant of outcome for patients with thoracic trauma.
Journal of Ayub Medical College, Abbottabad : JAMC
Blunt chest trauma is second leading cause of death among trauma patients. Early identification and aggressive management of blunt thoracic trauma is essential to reduce the significant rates of morbidity and mortality. Thoracic trauma severity score (TTS) is a better predictor of chest trauma related complications. The objective of the study was to compare outcomes between low-and high thoracic trauma severity score in blunt trauma chest patients. A cross sectional descriptive study was carried out in public and private sector hospitals of Rawalpindi, Pakistan from 2008 to 2012 and 264 patients with blunt trauma chest who reported to emergency department of the hospitals, within 48 hrs of trauma were recruited. All patients were subjected to detailed history and respiratory system examination to ascertain fracture ribs, flail segment and hemopneumothorax. Written and informed consent was taken from each patient. Permission was taken from ethical committee of the hospital. The patie...
Diagnostics and Scoring in Blunt Chest Trauma
European Journal of Trauma, 2002
Background: Blunt chest trauma is frequently present in patients with multiple trauma. In polytraumatized patients thoracic injuries have significant influence on the treatment strategy, not only in the emergency room but also in the intensive care unit. They also affect the decision-making concerning fracture management. The vital role played by blunt chest trauma in the outcome after multiple injuries is highlighted by the fact that polytraumatized patients with severe thoracic trauma have a higher mortality rate than patients with the same injury severity without thoracic trauma. Diagnostics and Injury Severity: Within the broad category of thoracic trauma, there are many different types of injuries. Therefore it is crucial for the treating physician to promptly make the correct diagnosis and to quantify the severity of the injury. This will allow the selection of an appropriate treatment protocol and ensure the best possible outcome for the patient. Scoring Systems: Additionally, various treatment protocols for management can only be evaluated scientifically if the assessment of the trauma severity is standardized. Thus, a reliable CT-independent classification of the severity of thoracic trauma is essential. The "Thoracic Trauma Severity Score" (TTS) is a CT-independent classification of thoracic trauma that is reliable and can be performed quickly in the emergency room. This will allow for adequate treatment of thoracic trauma and the prevention of secondary complications.
Predictors of Mortality in Patients with Isolated Chest Trauma
2021
Background: Chest trauma remained an important type of trauma that carries the risk of morbidity and mortality. The Modified Early Warning Score [MEWS] is a unique score as it is a physiological and simple score which permits improvement in the patient management. The aim of the work: To assess frequency, risk factors of mortality and examine MEWS as a predictor of mortality in patients with isolated chest trauma. Patients and Methods: Prospective analysis of 157 patients presented to emergency department, with isolated chest trauma. Demographic data, MEWS, trauma characteristics, and laboratory data were recorded on admission. The patients received standard management and were followed up until discharge or death. Results: Age of patients ranged from 4 to 79 years. Male constituted 79.6%. About 29% admitted with penetrating chest trauma. About 98% and 82% presented within 24 hours and had unilateral chest trauma. MEWS of them ranged from 0 to 12. There is a significant relationshi...
Determinants of mortality in chest trauma patients
Nigerian journal of surgery : official publication of the Nigerian Surgical Research Society, 2014
Chest trauma is an important trauma globally accounting for about 10% of trauma admission and 25-50% of trauma death. Different types and severity of chest trauma in different subsets of patients with varying associated injuries result in differing outcomes measured with mortality. Early mitigation of poor prognostic factors could result in improved outcome, therefore the need to know such factors or determinants of mortality in chest trauma patients. Retrospective and prospective analysis of demographic details, socio-economic, clinical details, modified early warning signs (MEWS) score on presentation, investigation findings, treatment and outcome of chest trauma patients who presented to our cardiothoracic surgery unit was undertaken. Data were collected and were analyzed using WINPEPI Stone Mountain, Georgia: USD Inc; 1995 statistical software. A total 149 patients with thoracic trauma were studied over a 5 year period constituting 40% of the unit workload. There were 121 males ...
Clinical Profile of Blunt Trauma Chest: A Hospital based Study
International Journal of Contemporary Medical Research [IJCMR], 2019
Blunt trauma to the chest is a very common occurrence in setting of traumatic incidents occurring with highest frequency in young adults between 15-35 years of age. Traumatic chest injuries lead to significant burden of mortality and morbidity in the young population. The most common modes of injury in such patients is motor vehicle accidents followed by other high energy traumatic scenarios like falls from height, contact sports, violence etc. This study was aimed at the evaluation and management of BCT with rib fractures and associated injuries. Material and Methods: The present study was a retrospective cum prospective hospital based study done in SKIMS Medical College Hospital, Srinagar, J & K, India. Sixty four patients who attended the Emergency Department with history of blunt chest injury were included in the study. Patients of all genders between 18 and 65 years of age were included in the study. The data regarding age, gender, mode of injury, presence of thoracic injuries, abdominal injuries, skeletal injuries was gathered and tabulated. Results: We observed a strong male preponderance with 45 out of 64 patients being male. Most common mode of injury was traffic accidents followed by falls from height, fall of heavy objects, hit by animals, violence and contact sports. Associated injuries were seen in both thoracic and extra-thoracic organs. Musculoskeletal injuries were also commonly seen. Patients were managed according to ATLS protocol; fifteen patients were managed with intercostal tube drainage four of which required thoracotomy, four patients required laparotomy for visceral injuries, four patients required fixation of vertebral fractures and musculoskeletal injuries were managed according to the orthopaedic protocols. In the present study four (6.25%) died as a result of massive thoracic injuries. Conclusion: Blunt chest injury is a serious injury which can result in life threatening complications which need to be anticipated, identified and adequately managed to reduce the rates of poor outcome. Integrated management employing the general surgeon, anesthetist, orthopaedician, internist and relevant paramedics is essential. Strict adherence to ATLS protocol is imperative. Adequate fluid resuscitation, ventilatory support, O 2 inhalation, pulmonary physical therapy and efficient analgesia can lead to quick recovery and reduced rates of surgical intervention.