Contemporary assessment of laryngotracheal trauma.
OBJECTIVE
Laryngotracheal trauma is a rare and potentially deadly spectrum of injuries. We sought to characterize the contemporary mechanisms, diagnostic modalities, and outcomes common in laryngotracheal trauma today.


METHODS
We performed a retrospective analysis of all laryngotracheal trauma cases at 2 major metropolitan hospitals between 1996 and 2004, detailing mechanisms, associated injuries, diagnostic modalities, and outcomes of laryngotracheal trauma.


RESULTS
We identified 71 patients with a mean age of 32.8 +/- 13.3 years (range, 15-71 years). In our series penetrating trauma was the cause in 73.2% of patients; however, blunt trauma had a significantly higher mortality (63.2% vs 13.5%, respectively; P < .0001). Blunt mechanisms involved older patients (38.5 +/- 15.2 years vs 30.1 +/- 11.9 years, P = .017), and these patients were more likely to require emergency airways than those with penetrating trauma (78.9% vs 46.2%, P = .017). The requirement of an emergency airway was an independent predictor of mortality (P = .0066).


CONCLUSIONS
Laryngotracheal trauma is a deadly spectrum of injuries with a mortality of 26.8%. Blunt mechanisms are decreasing in frequency. This might reflect improvements in automobile safety. Additionally, violent crime is on the increase, producing penetrating injuries with increasing frequency. The most fundamental intervention for patients with laryngotracheal injury is airway control. Either routine intubation or a tracheostomy can secure the airway. Blunt trauma and the requirement of an emergency airway are independent predictors of mortality. Laryngotracheal trauma requires prompt recognition, airway protection, and skillful management to lessen the mortality of this deadly spectrum of injuries.
Bhojani
Rehal A
RA
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Rosenbaum
David H
DH
Dikmen
Erkan
E
Paul
Michelle
M
Atkins
B Zane
BZ
Zonies
David
D
Estrera
Aaron S
AS
Wait
Michael A
MA
Meyer
Dan M
DM
Jessen
Michael E
ME
DiMaio
J Michael
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007830:Larynx / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D014132:Trachea / Q000293:injuries*; D014140:Tracheotomy; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy