scholarly journals Costal cartilage fracture: A commonly missed thoracic injury in trauma patients

2022 ◽  
Vol 17 (1) ◽  
pp. 95-98
Author(s):  
Moussa Meteb ◽  
Bader Abou Shaar ◽  
Ghassan Awad El-Karim ◽  
Youssef Almalki
Keyword(s):  
Costal Cartilage ◽  
Thoracic Injury ◽  
Trauma Patients

scholarly journals Early Packed Red Blood Cell Transfusion and Acute Respiratory Distress Syndrome after Trauma

2009 ◽  
Vol 110 (2) ◽  
pp. 351-360 ◽  
Author(s):  
Onuma Chaiwat ◽  
John D. Lang ◽  
Monica S. Vavilala ◽  
Jin Wang ◽  
Ellen J. MacKenzie ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Distress Syndrome ◽  
Red Blood Cell Transfusion ◽  
Thoracic Injury ◽  
National Study ◽  
Trauma Patients

Background Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. Yet, there is a paucity of information regarding the risk of ARDS with incremental PRBCs exposure. Methods For this retrospective analysis, eligible patients from National Study on Costs and Outcomes of Trauma were included. Our main exposure was defined as units of PRBCs transfused during the first 24 h after admission. The main outcome was ARDS. Results A total of 521 (4.6%) of 14070 patients developed ARDS, and 331 patients (63.5%) who developed ARDS received PRBCs transfusion. Injury severity, thoracic injury, polytrauma, and pneumonia receiving more than 5 units of fresh frozen plasma and 6-10 units of PRBCs were independent predictors of ARDS. Patients receiving more than 5 units of PRBCs had higher risk of developing ARDS (patients who received 6-10 units: adjusted odds ratio 2.5, 95% CI 1.12-5.3; patients who received more than 10 units: odds ratio 2.6, 95% CI 1.1-6.4). Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS (adjusted odds ratio 1.06; 95% CI 1.03-1.10). Conclusions Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.

Blunt Cardiac Injury: A Single-Center 15-Year Experience

2020 ◽  
Vol 86 (4) ◽  
pp. 354-361
Author(s):  
Jin-Mou Gao ◽  
Hui Li ◽  
Gong-Bin Wei ◽  
Chao-Pu Liu ◽  
Ding-Yuan Du ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Early Recognition ◽  
Cardiac Injury ◽  
Shock Rate ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Myocardial Contusion ◽  
Blunt Cardiac Injury ◽  
Group A ◽  
Group B

In recent years, the incidence of blunt cardiac injury (BCI) has increased rapidly and is an important cause of death in trauma patients. This study aimed to explore early diagnosis and therapy to increase survival. All patients with BCI during the past 15 years were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. The patients were divided into two groups according to the needs of their condition—nonoperative (Group A) and operative (Group B). Comparisons of the groups were performed. A total of 348 patients with BCI accounted for 18.3 per cent of 1903 patients with blunt thoracic injury. The main cause of injury was traffic accidents, with an incidence of 48.3 per cent. In Group A (n = 305), most patients sustained myocardial contusion, and the mortality was 6.9 per cent. In Group B (n = 43), including those with cardiac rupture and pericardial hernia, the mortality was 32.6 per cent. Comparisons of the groups regarding the shock rate and mortality were significant ( P < 0.01). Deaths directly resulting from BCI in Group B were greater than those in Group A ( P < 0.05). In all 348 patients, the mortality rate was 10.1 per cent. When facing a patient with blunt thoracic injury, a high index of suspicion for BCI must be maintained. To manage myocardial contusion, it is necessary to protect the heart, alleviate edema of the myocardium, and control arrhythmia with drugs. To deal with those requiring operation, early recognition and expeditious thoracotomy are essential.

scholarly journals Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria

2017 ◽  
Vol 6 (1) ◽  
pp. 30-34
Author(s):  
Luca GA Pivetta ◽  
Cristiano Below ◽  
Giovanna Z Rondini ◽  
Jacqueline AG Perlingero ◽  
José C Assef ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
X Rays ◽  
Chest Drainage ◽  
X Ray ◽  
Clinical Criteria ◽  
Chest X Ray ◽  
Low Probability ◽  
Excessive Number

ABSTRACT Background There is an excessive number of unnecessary chest X-rays (CXRs) in minor blunt trauma patients. Objective To identify, using routine clinical criteria, a subgroup of blunt trauma patients that do not require CXR for assessment. Materials and methods This was a retrospective analysis of trauma registry data collected over a 24-month period. Adult blunt trauma patients undergoing CXR on admission were analyzed. The following clinical criteria were assessed: Normal neurologic examination on admission (NNEx), hemodynamic stability (HS), normal physical examination of the chest on admission (NCEx), age ≤ 60 years, and absence of distracting injuries (Abbreviated Injury Scale >2 in head, abdomen, and extremities). These clinical criteria were progressively merged to select a group with lowest risk of exhibiting abnormal CXR on admission. Results Out of 4,647 patients submitted to CXR on admission, 268 (5.7%) had abnormal findings on scans. Of 2,897 patients admitted with NNEx, 116 (4.0%) had abnormal CXR. Of 2,426 patients with NNEx and HS, 74 (3.0%) had abnormal CXR. Of 1,698 patients with NNEx, HS, and NCEx, 24 (1.4%) had abnormal CXR. Of 1,347 patients with NNEx, HS, NCEx, and age < 60 years, 12 had thoracic injury (0.9% of total individuals receiving CXR). A total of 4 patients underwent chest drainage. Among 1,140 cases with all clinical criteria, 8 had confirmed thoracic injuries and 2 underwent chest drainage. Conclusion A subgroup of blunt trauma patients with low probability of exhibiting abnormalities on CXR at admission was identified. The need for CXR in this subgroup should be reviewed. How to cite this article Pivetta LGA, Parreira JG, Below C, Rondini GZ, Perlingero JAG, Assef JC. Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria. Panam J Trauma Crit Care Emerg Surg 2017;6(1):30-34.

scholarly journals Epidemiology and Impact of Thoracic Trauma on the Mortality of Multi-trauma Patients: Results From a French Road Trauma Registry 1997-2016

2021 ◽  
Author(s):  
Axel Benhamed ◽  
Amina Ndiaye ◽  
Marcel Emond ◽  
Thomas Lieutaud ◽  
Marion Douplat ◽  
...  
Keyword(s):  
Traffic Accident ◽  
Thoracic Trauma ◽  
Road Traffic ◽  
Head Injuries ◽  
Multivariate Regression Analysis ◽  
Thoracic Injury ◽  
Body Region ◽  
Trauma Patients ◽  
Abbreviated Injury Scale ◽  
Multiple Rib Fractures

Abstract Thoracic trauma is the third most common cause of death in multi-trauma patients. One of the most frequent mechanism is road traffic accident (RTA). The objective of the present study was to investigate the influence of severe (abbreviated injury scale, AIS≥3) injuries in each body region on the mortality of multi-trauma patients with a particular attention to thoracic trauma. We also described the epidemiology and injury pattern of these patients when presenting with at least one AIS ≥2 thoracic injury (AISThorax≥2). Patients included in the Rhône RTA registry between 1997 and 2016, with at least one AIS ≥2 injury in any body region were included. Two subgroups were defined according to whether patients presented at least one AISThorax≥2 injury or not. Multivariate regression analysis with mortality as outcome was performed. A total of 46,526 patients had at least one AIS≥2 injury, among them 6,382 (13.7%) had at least one AISThorax≥2 injury. Severe thoracic injuries (OR=12.2, 95%CI [8.4;17.7]) were strongly associated with death, second to severe head injuries were (OR=26.8, 95%CI [20.4;35.2]). Chest wall injuries were the most frequent thoracic injury (62.1%, n=5,419) and 52.4% of these were multiple rib fractures. Severe thoracic injury is a priority in multi-trauma patients; both in the detection but also in the management.

scholarly journals The SCRAP rule: The Derivation and Internal Validation of a Clinical Decision Rule for Computed Tomography of the Chest in Blunt Thoracic Trauma

CJEM ◽  
2012 ◽  
Vol 14 (06) ◽  
pp. 344-353 ◽  
Author(s):  
Julien Payrastre ◽  
Suneel Upadhye ◽  
Andrew Worster ◽  
Daren Lin ◽  
Kamyar Kahnamoui ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Likelihood Ratio ◽  
Decision Rule ◽  
Negative Likelihood Ratio ◽  
Clinical Decision ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Validation Group ◽  
Clinical Decision Rule ◽  
Gcs Score

ABSTRACTObjective:To derive and internally validate a clinical decision rule that will rule out major thoracic injury in adult blunt trauma patients, reducing the unnecessary use of chest computed tomographic (CT) scans.Methods:Data were retrospectively obtained from a chart review of all trauma patients presenting to a Canadian tertiary trauma care centre from 2005 to 2008, with those from April 2006 to March 2007 being used for the validation phase. Patients were included if they had an Injury Severity Score &gt; 12 and chest CT at admission or a documented major thoracic injury noted in the trauma database. Patients with penetrating injury, a Glasgow Coma Scale (GCS) score ≤ 8, paralysis, or age &lt; 16 years were excluded.Results:There were 434 patients in the derivation group and 180 in the validation group who met the inclusion criteria. Using recursive partitioning, five clinical variables were found to be particularly predictive of injury. When these variables were normal, no patients had a major thoracic injury (sensitivity 100% [95% CI 98.4–100], specificity 46.9% [95% CI 44.2–46.9], and negative likelihood ratio 0.00 [95% CI 0.00–0.04]). The five variables were oxygensaturation (&lt; 95% on room air or &lt; 98% on any supplemental oxygen),chest radiograph, respiratoryrate ≥ 25, chestauscultation, and thoracicpalpation (SCRAP). In the validation group, the same five variables had a sensitivity of 100% (95% CI 96.2–100%), a specificity of 44.7% (95% CI 39.5–44.7%), and negative likelihood ratio of 0.00 (95% CI 0.00–0.10).Conclusions:In major blunt trauma with a GCS score &gt; 8, the SCRAP variables have a 100% sensitivity for major thoracic injury in this retrospective study. These findings need to be prospectively validated prior to use in a clinical setting.

Does thoracic injury impair the predictive value of base deficit in trauma patients?

Injury ◽  
2010 ◽  
Vol 41 (9) ◽  
pp. 935-937 ◽  
Author(s):  
Tjeerd S. Aukema ◽  
Falco Hietbrink ◽  
Ludo F.M. Beenen ◽  
Luke P.H. Leenen
Keyword(s):  
Predictive Value ◽  
Base Deficit ◽  
Thoracic Injury ◽  
Trauma Patients

scholarly journals Leucocytosis in penetrating trauma (abdominal and thoracic/osseous): a transversal study in Juarez, México

2015 ◽  
Vol 15 (2) ◽  
pp. 220-225
Author(s):  
Juan de Dios Díaz-Rosales ◽  
Lenin Enríquez-Domínguez ◽  
Balthazar Aguayo-Muñoz ◽  
Beatriz Díaz-Torres
Keyword(s):  
Abdominal Trauma ◽  
Blood Cells ◽  
White Blood Cells ◽  
Penetrating Trauma ◽  
Human Anatomy ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Penetrating Abdominal Trauma ◽  
Major Injury ◽  
Transversal Study

Introduction: The abdominal trauma is an important cause of morbility and mortality, abdomen is the 3th zone of human anatomy more affected by traumatism that require surgery and hospitalization. Evaluation of penetrating abdominal trauma aims to identify patients that requires surgical treatment. Objective: The objective of this study was to compare white blood cells levels in patients with penetrating abdominal trauma isolated and associated with osseous and/or thoracic injury. Patients and methods:  A transversal study comparing two groups of abdominal penetrating trauma patients; penetrating abdominal trauma isolated versus penetrating abdominal trauma associated with osseous and or thoracic injury. We examined the level of white blood cells as a factor associated with major injury. Results: Our study showed a difference in mean of white blood cells count between the two groups that was statistically significant (p=0.01). A positive relationship between penetrating abdominal trauma associated with osseous and or thoracic injury was found. Conclusion: A significant elevation in white blood cells count in penetrating abdominal trauma associated with osseous and or thoracic injury is observed in comparison with penetrating abdominal trauma isolated.

Ageing population has changed the nature of major thoracic injury

2019 ◽  
Vol 36 (6) ◽  
pp. 340-345 ◽  
Author(s):  
Noha Ferrah ◽  
Peter Cameron ◽  
Belinda Gabbe ◽  
Mark Fitzgerald ◽  
Rodney Judson ◽  
...  
Keyword(s):  
System Design ◽  
Major Trauma ◽  
Trauma System ◽  
Age Groups ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Ageing Population ◽  
Thoracic Injuries ◽  
Pattern Of Injury ◽  
Trauma Population

IntroductionAn increasing proportion of the major trauma population are older persons. The pattern of injury is different in this age group and serious chest injuries represent a significant subgroup, with implications for trauma system design. The aim of this study was to examine trends in thoracic injuries among major trauma patients in an inclusive trauma system.MethodsThis was a retrospective review of all adult cases of major trauma with thoracic injuries of Abbreviated Injury Scale score of 3 or more, using data from the Victorian State Trauma Registry from 2007 to 2016. Prevalence and pattern of thoracic injury was compared between patients with multitrauma and patients with isolated thoracic injury. Poisson regression was used to determine whether population-based incidence had changed over the study period.ResultsThere were 8805 cases of hospitalised major trauma with serious thoracic injuries. Over a 10-year period, the population-adjusted incidence of thoracic injury increased by 8% per year (incidence rate ratio [IRR] 1.08, 95% CI 1.07 to 1.09). This trend was observed across all age groups and mechanisms of injury. The greatest increase in incidence of thoracic injuries, 14% per year, was observed in people aged 85 years and older (IRR 1.14, 95% CI 1.09 to 1.18).ConclusionsAdmissions for thoracic injuries in the major trauma population are increasing. Older patients are contributing to an increase in major thoracic trauma. This is likely to have important implications for trauma system design, as well as morbidity, mortality and use of healthcare resources.

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