Predictors of long-term survival in 5,680 patients admitted to a UK major trauma centre with thoracic injuries

INTRODUCTION

The long-term outcomes of chest trauma are largely unknown. We sought to determine the predictors of in-hospital and long-term survival in patients admitted to a major trauma centre (MTC) with chest injuries and to evaluate spatial patterns of injury in our network area.

METHODS

Retrospective analysis of data collected on the National Trauma Audit Research Network (TARN) database using multivariate analysis and Cox regression analysis. Spatial analysis was performed using ArcGis 10.7.1.

RESULTS

Some 5,680 patients were admitted with chest trauma between December 1999 and December 2019. Median patient age was 45 years and the median Injury Severity Score (ISS) was 20. The proportion of patients who had an operation was 39.8%. Age, blood transfusion, head injury, shock, emergency thoracotomy and heart disease were predictors of hospital mortality (p < 0.05). However, having an operation on concomitant injuries was protective. ISS and Glasgow Coma Score were discriminators of in-hospital mortality (C-indices 0.76 and 0.80, respectively). The 10-year survival values for patients who survived to discharge from hospital and who were aged <40, 50, 60, 70, 80 and >80 years were 99%, 93%, 95%, 87%, 75% and 43%, respectively. Preadmission lung disease and alcohol/drug misuse were poor predictors of long-term survival (p < 0.05). Hotspot analysis revealed the areas with the highest incidents were all close to the MTC.

CONCLUSIONS

The MTC is geographically central to areas with high numbers of trauma incidents. Although emergency thoracotomy was a predictor of poor in-hospital outcomes, having surgery for concomitant injuries improved outcomes. Patients surviving to discharge have good long-term survivals.

Improvement in initial survival of spinal injuries: a 10-year audit

A 10-year retrospective study of all spinal injuries presenting to the Leeds Teaching Hospitals between 1991 and 2001. The hospitals provide secondary care to a population of 750,000 and tertiary care to a population of 2-3 million. In total 1119 spinal injuries were studied. The overall survival rate was 89%. The commonest age group for presentation was 25-29 years with a secondary peak in the seventh decade, a mean overall of 43 years. 66% of injuries occurred in males. The commonest cause was a fall from a height (44%), with road traffic accidents (RTA) causing 43%. Pedestrians were most at risk within the road traffic group, making up 63% of cases. Isolated cervical spine injuries made up 37% of all cases. Cervical fractures were most associated with neurological injury (50%). Immediate survival has increased over the decade from 83% in 1991 to 93% in 2001. The probability of survival was significant at P = 0.006 and actual survival at P = 0.012 (Pearson correlation). The causal analysis has not been carried out but it is thought likely that improved quality of care is responsible.

Head injuries in Leeds: changes in epidemiology and survival over 12 years

OBJECTIVES

To map the pattern of survival and epidemiology of patients admitted to accident and emergency, at a regional neurosciences unit with an isolated head injury, over a 12 year period.

METHODS

The TARN database of a regional neuroscience referral centre was analysed to identify patients who where admitted after a significant, isolated head injury between January 1990 and December 2001. Demographic data about the patient and nature and cause of the injury were extracted and survival was mapped over the time period. Statistical analysis was performed to identify change in survival.

RESULTS

There were 810 eligible patients. The most common cause of injury was road traffic accident (47%) with an average of 42.6% patients transferred from other hospitals. The most common disposal of patients was to an intensive care unit (35%). There was an overall increase in the number of patients but survival did not increase over the time period. Mean survival was 81.8% and overall survival decreased from 95.0% in 1990 to 81.6% in 2001, although this did not represent significant change (p = 0.990).

CONCLUSIONS

Short term survival after significant head injury has not changed significantly over the 12 year period studied. No subset of patients is having a disproportionate effect on survival but in patients aged over 75, survival increased significantly. Further multicentre work is indicated to map a more accurate clinical picture of head injury survival.