Thoracic trauma: an analysis of 187 patients.
A retrospective analysis of 187 cases of thoracic trauma seen between January 1, 1994 and June 30, 1999 is presented. The majority of the patients were male (male-female ratio 2.9:1) and the average age at admission was 41.1 years. Blunt trauma, especially motor vehicle accidents (72.2%) and falls (17.1%), were the most frequent causes of chest injury (95.8%). We used the injury severity score (ISS) to assess the severity of trauma. The average ISS for the total group was 27.8 (ranges: 4-75). In only 17.6% of the patients an isolated thoracic trauma was present. Rib fractures (n = 133), pulmonary contusion (n = 110), pneumothorax (n = 78) and haemothorax (n = 65) were the most frequent lesions. Most patients (97.9%) were admitted to the intensive care department. A minority of the patients required thoracotomy (n = 19, 10.2%). Main indications for thoracotomy were pulmonary laceration (n = 5), aortic rupture (n = 3) and rupture of the diaphragm (n = 3). For the majority of cases, observation and/or tube thoracostomy (52.4%) and/or mechanical ventilation (61.0%) were sufficient. Pneumonia and adult respiratory distress syndrome were the most common complications (38.0 and 7.0% respectively). The overall mortality rate was 16.6%. Main causes of death were intracranial hypertension, sepsis combined with multiple organ failure, and hypovolaemic shock. For patients who did not survive the average ISS was 40.3. In a survival analysis the ISS was found to be the most significant determining survival (p < 0.0001), followed by neurotrauma (p = 0.05). Mortality after thoracic trauma remains relatively high, especially in case of associated neurotrauma. The ISS is a valuable score for assessing the severity of trauma and predicting outcome.
Segers
P
P
Departments of Thoracic and Vascular Surgery and of Intensive Care, University Hospital of Antwerp, Edegem, Belgium.
Van Schil
P
P
Jorens
P
P
Van Den Brande
F
F
D000058:Accidental Falls / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001019:Aortic Rupture / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003964:Diaphragm / Q000293:injuries; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012253:Rib Fractures / Q000453:epidemiology; D012421:Rupture; D013898:Thoracic Injuries / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D013908:Thoracotomy; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000401:mortality / Q000601:surgery