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Cheng Q, Lai X, Yang L, Yang H, Luo Y. Serum CD5L predicts acute lung parenchymal injury and acute respiratory distress syndrome in trauma patients. Medicine (Baltimore) 2021; 100:e27219. [PMID: 34596119 PMCID: PMC8483880 DOI: 10.1097/md.0000000000027219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/26/2021] [Indexed: 01/05/2023] Open
Abstract
Cluster of differentiation 5 antigen-like (CD5L), derived from alveolar epithelial cells partly, is a secreted protein. It is shown that CD5L is associated with lung inflammation and systemic inflammatory diseases, but the relationship between CD5L and trauma-related acute lung parenchymal injury (PLI), acute lung injury or acute respiratory distress syndrome (ARDS) is unclear. This study aims to explore the value of serum CD5L levels in predicting trauma-associated PLI/ARDS and its potential clinical significance.This is a prospective observational study, and a total of 127 trauma patients were recruited from the emergency department (ED), and among them, 81 suffered from PLI/ARDS within 24 hours after trauma, and 46 suffered from trauma without PLI/ARDS. Fifty healthy subjects from the medical examination center were also recruited as controls for comparison. The serum CD5L level was measured within 24 hours of admission. The receiver operating characteristic analysis and logistic regression analysis were used to identify the correlation between high CD5L and trauma associated-PLI/ARDS within 24 hours following trauma.The trauma associated-PLI/ARDS subjects showed a significantly higher level of serum CD5L on emergency department admission within 24 hours after trauma compared with its level in non-trauma associated-PLI/ARDS subjects and healthy subjects. The initial CD5L concentration higher than 150.3 ng/mL was identified as indicating a high risk of PLI/ARDS within 24 hours following trauma (95% confidence interval: 0.674-0.878; P < .001). Moreover, CD5L was an independent risk factor for trauma associated-PLI/ARDS within 24 hours following trauma.CD5L could predict PLI/ARDS within 24 hours following trauma.
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Affiliation(s)
- Qian Cheng
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China
| | - Xiaofei Lai
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China
| | - Liping Yang
- Department of Laboratory Medicine, Guangyuan Central Hospital, No. 16 Jingxiangzi Road, Lizhou District, Guangyuan City, Sichuan Province, China
| | - Huiqing Yang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China
| | - Yan Luo
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China
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Cornillon A, Balbo J, Coffinet J, Floch T, Bard M, Giordano-Orsini G, Malinovsky JM, Kanagaratnam L, Michelet D, Legros V. The ROX index as a predictor of standard oxygen therapy outcomes in thoracic trauma. Scand J Trauma Resusc Emerg Med 2021; 29:81. [PMID: 34154631 PMCID: PMC8215800 DOI: 10.1186/s13049-021-00876-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thoracic trauma is commonplace and accounts for 50-70% of the injuries found in severe trauma. Little information is available in the literature as to timing of endotracheal intubation. The main objective of this study was to assess the accuracy of the ROX index in predicting successful standard oxygen (SO) therapy outcomes, and in pre-empting intubation. METHODS Patient selection included all thoracic trauma patients treated with standard oxygen who were admitted to a Level I trauma center between January 1, 2013 and April 30, 2020. Successful standard SO outcomes were defined as non-requirement of invasive mechanical ventilation within the 7 first days after thoracic trauma. RESULTS One hundred seventy one patients were studied, 49 of whom required endotracheal intubation for acute respiratory distress (28.6%). A ROX index score ≤ 12.85 yielded an area under the ROC curve of 0.88 with a 95% CI [0.80-0.94], 81.63sensitivity, 95%CI [0.69-0.91] and 88.52 specificity, 95%CI [0.82-0.94] involving a Youden index of 0.70. Patients with a median ROX index greater than 12.85 within the initial 24 h were less likely to require mechanical ventilation within the initial 7 days of thoracic trauma. CONCLUSION We have shown that a ROX index greater than 12.85 at 24 h was linked to successful standard oxygen therapy outcomes in critical thoracic trauma patients. It is our belief that an early low ROX index in the initial phase of trauma should heighten vigilance on the part of the attending intensivist, who has a duty to optimize management.
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Affiliation(s)
- Adrien Cornillon
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France
| | - Juliette Balbo
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France
| | - Julien Coffinet
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France
| | - Thierry Floch
- Surgical and Trauma Intensive Care Unit, Reims University Hospital, 45 rue Cognacq Jay, 51092, Reims Cedex, France
| | - Mathieu Bard
- Surgical and Trauma Intensive Care Unit, Reims University Hospital, 45 rue Cognacq Jay, 51092, Reims Cedex, France.,University of Reims Champagne Ardennes, Reims, France
| | - Guillaume Giordano-Orsini
- University of Reims Champagne Ardennes, Reims, France.,Department of Emergency Medicine, Reims University Hospital, Reims, France
| | - Jean-Marc Malinovsky
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France.,University of Reims Champagne Ardennes, Reims, France
| | - Lukshe Kanagaratnam
- University of Reims Champagne Ardennes, Reims, France.,Clinical Research Unit, Reims University Hospital, Reims, France
| | - Daphne Michelet
- Department of Anesthesiology and critical care, Reims University Hospital, Reims, France
| | - Vincent Legros
- Surgical and Trauma Intensive Care Unit, Reims University Hospital, 45 rue Cognacq Jay, 51092, Reims Cedex, France.
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Bagaria V, Mathur P, Madan K, Kumari M, Sagar S, Gupta A, Soni KD, Bhattacharjee H, Kumar S. Predicting Outcomes After Blunt Chest Trauma-Utility of Thoracic Trauma Severity Score, Cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α), and Biomarkers (vWF and CC-16). Indian J Surg 2020; 83:113-119. [PMID: 32837068 PMCID: PMC7275928 DOI: 10.1007/s12262-020-02407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/22/2020] [Indexed: 11/18/2022] Open
Abstract
Thoracic trauma severity score (TTSS) has been used to assess severity and risk of pulmonary complications in patients with chest trauma. The role of cytokines and biomarkers in patients with chest trauma and its association with TTSS is not well elucidated. The aim of the study was to assess the cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α) and biomarkers (vWF, CC-16) in patients of thoracic trauma and correlate it with TTSS and patient’s outcome. This was a prospective observational study. Serum and bronchoalveolar lavage fluid samples were collected from chest trauma patients. TTSS was calculated in all patients. Suitable controls for serum and bronchoalveolar lavage (BAL) sample were selected. The outcome parameters included patient discharge or death, duration of hospital, and intensive care unit (ICU) stay. Forty-three patients were included. There was no significant correlation between the measured cytokines and biomarkers and TTSS. The mean TTSS of patients who had a fatal outcome was significantly higher than the patients who recovered. Patients with a high TTSS score had a significant prolonged ICU stay. Patients with a prolonged hospital stay had lower values of CC-16. TTSS is a useful tool to predict severity of chest trauma and prolonged ICU stay. Lower levels of CC-16 in BAL fluid of chest trauma patients were associated with prolonged hospital stay suggestive of its protective role in the airway. Longer prospective studies are required to determine the role of cytokines and biomarkers in patients with thoracic trauma in predicting the patient’s outcome.
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Affiliation(s)
- Vivek Bagaria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Kumari
- Division of Trauma Surgery & Critical Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery & Critical Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Division of Trauma Surgery & Critical Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Division of Trauma Surgery & Critical Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Hemanga Bhattacharjee
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Division of Trauma Surgery & Critical Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
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Beks RB, Reetz D, de Jong MB, Groenwold RHH, Hietbrink F, Edwards MJR, Leenen LPH, Houwert RM, Frölke JPM. Rib fixation versus non-operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: a multicenter cohort study. Eur J Trauma Emerg Surg 2018; 45:655-663. [PMID: 30341561 PMCID: PMC6689036 DOI: 10.1007/s00068-018-1037-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/12/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Over the years, a trend has evolved towards operative treatment of flail chest although evidence is limited. Furthermore, little is known about operative treatment for patients with multiple rib fractures without a flail chest. The aim of this study was to compare rib fixation based on a clinical treatment algorithm with nonoperative treatment for both patients with a flail chest or multiple rib fractures. METHODS All patients with ≥ 3 rib fractures admitted to one of the two contributing hospitals between January 2014 and January 2017 were retrospectively included in this multicenter cohort study. One hospital treated all patients nonoperatively and the other hospital treated patients with rib fixation according to a clinical treatment algorithm. Primary outcome measures were intensive care length of stay and hospital length of stay for patients with a flail chest and patients with multiple rib fractures, respectively. To control for potential confounding, propensity score matching was applied. RESULTS A total of 332 patients were treated according to protocol and available for analysis. The mean age was 56 (SD 17) years old and 257 (77%) patients were male. The overall mean Injury Severity Score was 23 (SD 11) and the average number of rib fractures was 8 (SD 4). There were 92 patients with a flail chest, 37 (40%) had rib fixation and 55 (60%) had non-operative treatment. There were 240 patients with multiple rib fractures, 28 (12%) had rib fixation and 212 (88%) had non-operative treatment. For both patient groups, after propensity score matching, rib fixation was not associated with intensive care unit length of stay (for flail chest patients) nor with hospital length of stay (for multiple rib fracture patients), nor with the secondary outcome measures. CONCLUSION No advantage could be demonstrated for operative fixation of rib fractures. Future studies are needed before rib fixation is embedded or abandoned in clinical practice.
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Affiliation(s)
- Reinier B Beks
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands. .,Utrecht Traumacenter, Utrecht, The Netherlands.
| | - David Reetz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mirjam B de Jong
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Michael J R Edwards
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Roderick Marijn Houwert
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.,Utrecht Traumacenter, Utrecht, The Netherlands
| | - Jan Paul M Frölke
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Park HO, Kang DH, Moon SH, Yang JH, Kim SH, Byun JH. Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:346-354. [PMID: 29124026 PMCID: PMC5628962 DOI: 10.5090/kjtcs.2017.50.5.346] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 12/04/2022]
Abstract
Background Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). Conclusion Severe pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.
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Affiliation(s)
- Hyun Oh Park
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
| | - Dong Hoon Kang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine
| | - Seong Ho Moon
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
| | - Jun Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
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Moon SH, Kim JW, Byun JH, Kim SH, Choi JY, Jang IS, Lee CE, Yang JH, Kang DH, Kim KN, Park HO. The thorax trauma severity score and the trauma and injury severity score: Do they predict in-hospital mortality in patients with severe thoracic trauma?: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e8317. [PMID: 29049240 PMCID: PMC5662406 DOI: 10.1097/md.0000000000008317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 12/04/2022] Open
Abstract
Several scoring systems are commonly used to evaluate severity in patients with traumatic injuries. However, there is no generally accepted standard scoring system to assess the severity of thoracic trauma, specifically in patients who have sustained severe injuries. The present study aimed to evaluate the validity of the trauma and injury severity score (TRISS) and the thorax trauma severity score (TTSS) as predictors of in-hospital mortality in patients with severe thoracic trauma.We conducted a retrospective, consecutive review of the medical records of patients with severe thoracic trauma who were managed at our institution between January 2005 and December 2015. Inclusion criteria were patients with severe thoracic injury (injury severity score > 18) who required intensive care therapy and who had no local or systemic infection. We analyzed the association between the trauma severity scores (TTSS and TRISS) and in-hospital mortality in these patients. We also determined the predictive value of the scores using receiver-operating characteristic (ROC) curves.A total of 228 patients with severe thoracic trauma were included in this study. The in-hospital mortality rate was 21.9%. There was a statistically significant association between the TRISS and in-hospital mortality (P < .001), but the association between the TTSS and in-hospital mortality was not statistically significant (P = .547). The ROC curve demonstrated adequate discrimination, as demonstrated by an area under the curve value of 0.787 for the TRISS. At a cut-off value of 25.9%, the TRISS had a sensitivity of 83.6% and specificity of 73.5% to predict in-hospital mortality.The present study demonstrated that the TRISS, but not the TTSS, can be used to predict in-hospital mortality in patients with severe thoracic trauma; hence, additional prospective studies are required.
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Affiliation(s)
- Seong Ho Moon
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon
| | - Jong Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon
| | - Jun Young Choi
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - In Seok Jang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chung Eun Lee
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jun Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dong Hun Kang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Nyun Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon
| | - Hyun Oh Park
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon
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Ekpe EE, Eyo C. Effect of analgesia on the changes in respiratory parameters in blunt chest injury with multiple rib fractures. Ann Afr Med 2017; 16:120-126. [PMID: 28671152 PMCID: PMC5579895 DOI: 10.4103/aam.aam_73_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Blunt chest injury with multiple rib fractures can result in such complications as pneumonia, atelectasis, bronchiectasis, empyema thoracis, acute respiratory distress syndrome, and prolonged Intensive Care Unit and hospital stay, with its concomitant mortality. These may be prevented or reduced by good analgesic therapy which is the subject of this study. METHODS This was a prospective study of effects of analgesia on changes in pulmonary functions of patients with traumatic multiple rib fractures resulting from blunt chest injury. RESULTS There were 64 adult patients who were studied with multiple rib fractures caused by blunt chest trauma. Of these patients, 54 (84.4%) were male and 10 (15.6%) were female. Motorcycle (popularly known as "okada") and tricycle (popularly known as keke napep) accidents significantly accounted for the majority of the multiple rib fractures, that is, in 50 (78.1%) of the patients. Before analgesic administration, no patient had a normal respiratory rate, but at 1 h following the administration of analgesic, 21 (32.8%) of patients recorded normal respiratory rates and there was a significant reduction in the number (10.9% vs. 39.1%) of patients with respiratory rates> 30 breaths/min. Before commencement of analgesic, no patient recorded up to 99% of oxygen saturation (SpO2) as measured by pulse oximeter, while 43.8% recorded SpO2of 96%. This improved after 1 h of administration of analgesics to SpO2of 100% in 18.8% of patients and 99% in 31.3% of patients and none recording SpO2of < 97% (P = 0.006). Before analgesia, no patient was able to achieve peak expiratory flow rate (PEFR) value> 100% of predicted while only 9 (14.1%) patients were able to achieve a PEFR value in the range of 91%-100% of predicted value. One hour after analgesia, a total of 6 (9.4%) patients were able to achieve PEFR values> 100% predicted, while 35 (54.7%) patients achieved PEFR values in the range of 91%-100% predicted. CONCLUSION Adequate analgesia is capable of reversing the negative effects of chest pain of traumatic multiple rib fractures on pulmonary function parameters through improvement in respiratory mechanics.
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Affiliation(s)
- Eyo Effiong Ekpe
- Department of Surgery, Cardiothoracic Surgery Unit, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Catherine Eyo
- Department of Anaesthesia, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
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Chien CY, Chen YH, Han ST, Blaney GN, Huang TS, Chen KF. The number of displaced rib fractures is more predictive for complications in chest trauma patients. Scand J Trauma Resusc Emerg Med 2017; 25:19. [PMID: 28241883 PMCID: PMC5330007 DOI: 10.1186/s13049-017-0368-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/21/2017] [Indexed: 01/18/2023] Open
Abstract
Background Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increase in chest complications. Methods We retrospectively reviewed the trauma registry between January 2013 and May 2015 in a teaching hospital in northeastern Taiwan. Patients admitted with chest trauma and rib fractures without concomitant severe brain, splenic, pelvic or liver injuries were included. The demographic data, such as gender, age, the index of coexistence disease, alcohol consumption, trauma mechanisms were analyzed as potential predictors of pulmonary complications. Pulmonary complications were defined as pneumothorax, hemothorax, flail chest, pulmonary contusion, and pneumonia. Results In the 29 months of the study period, a total of 3151 trauma patients were admitted to our hospital. Among them, 174 patients were enrolled for final analysis. The most common trauma mechanism was road traffic accidents (58.6%), mainly motorbike accidents (n = 70, 40.2%). Three or more displaced rib fractures had higher specificity for predicting complications, compared to three or more total rib fractures (95.5% vs 59.1%). Adjusting the severity of chest trauma using TTSS and Ribscore by multivariable logistic regression analysis, we found that three or more rib fractures or any displaced rib fracture was the most significant predictor for developing pulmonary complication (aOR: 5.49 95% CI: 1.82–16.55). Furthermore, there were 18/57 (31.6%) patients with fewer than three ribs fractures developed pulmonary complications. In these 18 patients, only five patients had delayed onset complications and four of them had at least one displaced rib fracture. Discussion In this retrospective cohort study, we found that the number of displaced or total rib fractures, bilateral rib fractures, and rib fractures in more than two areas were associated with the more chest complications. Furthermore, three or more rib fracture or any displacement were found to be the most sensitive risk factor for chest complications, independent of other risk factors or severity index. Conclusion The number of displaced rib fractures could be a strong predictor for developing pulmonary complications. For patients with fewer than three rib fractures without rib displacement and initial lung or other organ injuries, outpatient management could be safe and efficient. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0368-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chih-Ying Chien
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Hsien Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shih-Tsung Han
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Gerald N Blaney
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ting-Shuo Huang
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. .,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan. .,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.
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9
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Martínez Casas I, Amador Marchante MA, Paduraru M, Fabregues Olea AI, Nolasco A, Medina JC. Thorax Trauma Severity Score: Is it reliable for Patient's Evaluation in a Secondary Level Hospital? Bull Emerg Trauma 2016; 4:150-155. [PMID: 27540549 PMCID: PMC4989041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/03/2016] [Accepted: 06/20/2016] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To determine the predictive and diagnostic value of thorax trauma severity score (TTSS) in a population of thoracic trauma patients admitted to a secondary level trauma center. METHODS A Retrospective analysis of patients admitted over a period of two years with IDC-9 codes related to thoracic trauma was undertaken. The association of TTSS with complications and mortality was evaluated. We also determined the predictive value of TTSS using receiver operating characteristic curve (ROC). RESULTS 238 patients with thoracic trauma, mostly middle-aged (62.2 ± 15 years), were included. The main mechanisms of injury were falls and traffic accidents. Thirty-three patients had important extra-thoracic injuries, but only 9 presented an ISS> 15. The average ISS was 3 ± 5; Morbidity was 2.5% and mortality was 2.1% as a result of thoracic injury and these patients had significantly higher TTSS values. Each score component was analyzed separately, showing significant association with complications and mortality. The area under the curve for TTSS was significant for predicting complications (0.848) and mortality (0.856) values. TTSS with a cut off value of 8 points had a sensitivity of 66% and specificity of 94% to predict complications and 80% sensitivity and 94% specificity for predicting mortality. CONCLUSIONS The TTSS is an appropriate and feasible tool to predict the development of complications or mortality in a population of mostly mild thoracic trauma.
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Affiliation(s)
| | | | - Mihai Paduraru
- General and Digestive Surgery Department, Hospital de Tomelloso, Ciudad Real
| | | | - Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Spain.
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El-Menyar A, Abdelrahman H, Al-Hassani A, Ellabib M, Asim M, Zarour A, Al-Thani H. Clinical Presentation and Time-Based Mortality in Patients With Chest Injuries Associated With Road Traffic Accidents. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e31888. [PMID: 27148499 PMCID: PMC4853503 DOI: 10.5812/atr.31888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022]
Abstract
Background: Blunt chest trauma (BCT) poses significant morbidity and mortality worldwide. Objectives: We investigated the clinical presentation and outcome of BCT related to road traffic accidents (RTA). Patients and Methods: A retrospective observational analysis for patients who sustained BCT secondary to RTA in terms of motor vehicle crash (MVC) and pedestrian-motor vehicle accidents (PMVA) who were admitted to the trauma center at Hamad general hospital, Doha, Qatar, between 2008 and 2011. Results: Of 5118 traumatic injury cases, 1004 (20%) were found to have BCT secondary to RTA (77% MVC and 23% PMVA). The majority were males (92%), and expatriates (72%). Among MVCs, 84% reported they did not use protective devices. There was a correlation between chest abbreviated injury score (AIS) and injury severity scoring (ISS) (r = 0.35, r2 = 0.12, P < 0.001). Regardless of mechanism of injury (MOI), multivariate analysis showed that the head injury associated with chest AIS and ISS was a predictor of mortality in BCT. Overall mortality was 15%, and the highest rate was observed within the first 24 hours post-trauma. Conclusions: Blunt chest trauma from RTA represents one-fifth of the total trauma admissions in Qatar, with a high overall mortality. Pedestrians are likely to have more severe injuries and higher fatality rates than MVC victims. Specific injury prevention programs focusing on road safety should be implemented to minimize the incidence of such preventable injuries.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Corresponding author: Ayman El-Menyar, Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. Tel: +974-44394029, E-mail:
| | | | | | | | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ahmad Zarour
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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