Kinetic therapy in multiple trauma patients with severe blunt chest trauma: an analysis at a level-1 trauma center.
OBJECTIVE
Chest trauma is a relevant risk factor for mortality after multiple trauma. Kinetic therapy (KT) represents a potential treatment option in order to restore pulmonary function. Decision criteria for performing kinetic therapy are not fully elucidated. The purpose of this study was to investigate the decision making process to initiate kinetic therapy in a well defined multiple trauma cohort.


METHODS
A retrospective analysis (2000-2009) of polytrauma patients (age > 16 years, ISS ⩾ 16) with severe chest trauma (AIS(Chest) ⩾ 3) was performed. Patients with AIS(Head) ⩾ 3 were excluded. Patients receiving either kinetic (KT+) or lung protective ventilation strategy (KT-) were compared. Chest trauma was classified according to the AIS(Chest), Pulmonary Contusion Score (PCS), Wagner Jamieson Score and Thoracic Trauma Severity Score (TTS). There were multiple outcome parameters investigated included mortality, posttraumatic complications and clinical data. A multivariate regression analysis was performed.


RESULTS
Two hundred and eighty-three patients were included (KT+: n=160; KT-: n=123). AIS(Chest), age and gender were comparable in both groups. There were significant higher values of the ISS, PCS, Wagner Jamieson Score and TTS in group KT+. The incidence of posttraumatic complications and mortality was increased compared to group KT- (p< 0.05). Despite that, kinetic therapy failed to be an independent risk factor for mortality in multivariate logistic regression analysis.


CONCLUSIONS
Kinetic therapy is an option in severely injured patients with severe chest trauma. Decision making is not only based on anatomical aspects such as the AIS(Chest), but on overall injury severity, pulmonary contusions and physiological deterioration. It could be assumed that the increased mortality in patients receiving KT is primarily caused by these factors and does not reflect an independent adverse effect of KT. Furthermore, KT was not shown to be an independent risk factor for mortality.
Trauma Department, Hannover Medical School, Hannover, Germany.
C
C
Zeckey
Trauma Department, Hannover Medical School, Hannover, Germany.
K
K
Wendt
Trauma Department, Hannover Medical School, Hannover, Germany.
P
P
Mommsen
Trauma Department, Hannover Medical School, Hannover, Germany.
M
M
Winkelmann
Institute of Biostatistics, Hannover Medical School, Hannover, Germany.
C
C
Frömke
Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
J
J
Weidemann
Trauma Department, Hannover Medical School, Hannover, Germany.
T
T
Stübig
Trauma Department, Hannover Medical School, Hannover, Germany.
C
C
Krettek
Department of Orthopedic Trauma, University Hospital Aachen, Aachen, Germany.
F
F
Hildebrand
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006801:Humans; D015601:Injury Severity Score; D007699:Kinesthesis / Q000502:physiology; D055370:Lung Injury / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D026741:Physical Therapy Modalities; D011030:Pneumothorax / Q000175:diagnosis / Q000628:therapy; D020127:Recovery of Function; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013898:Thoracic Injuries / Q000175:diagnosis / Q000628:therapy; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult
Multiple trauma; blunt chest trauma; kinetic therapy; outcome; posttraumatic complications