Concomitant Sternal Fracture in Flail Chest: An Analysis of 21,741 Polytrauma Patients from the TraumaRegister DGU®

Background Isolated sternal fractures (SFs) rarely show complications, but their influence in a thorax trauma of the seriously injured still remains unclear. Methods A retrospective analysis of the TraumaRegister DGU® was performed involving the years 2009 to 2013 (Injury Severity Score [ISS] ≥ 16, primary admission to a trauma center). Cohort formation: Unilateral and bilateral flail chest (FC) injuries with and without a concomitant SF, respectively. Results In total, 21,741 patients (25% female) met the inclusion criteria, with 3,492 (16.1%) showing SF. Unilateral FC patients were on average 53.6 ± 18.4 years old, and bilateral FC patients were on average 55.2 ± 17.7 years old. The ISS in unilateral FC and bilateral FC amounted to 31.2 ± 13.0 and 43.4 ± 13.1 points, respectively. FC with an SF occurred more frequently as an injury to car occupants and less frequently as an injury to motorcyclists or in injuries due to falls. Conclusion Patients with an SF additional to an FC had longer hospital and intensive care unit stays and were longer artificially respirated than those patients without an SF. SF indicates possible cardiac and thoracic spine injuries.

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The assessment of clinical evaluation and treatment results of high-energy blunt polytrauma patients

Medicina ◽

10.3390/medicina43020017 ◽

2007 ◽

Vol 43 (2) ◽

pp. 137 ◽

Cited By ~ 2

Author(s):

Algimantas Pamerneckas ◽

Andrei Pijadin ◽

Giedrius Pilipavičius ◽

Gintaras Tamulaitis ◽

Vytautas Toliušis ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Stay ◽

Injury Severity ◽

Motor Vehicle ◽

High Energy ◽

Ventilation Time ◽

Polytrauma Patients ◽

The Mean

The aim of this study was to evaluate the mechanism of high-energy blunt trauma, age and gender of patients, severity of regional and multiple injury, ventilation time, length of stay in intensive care unit and in-hospital stay, in-hospital complications, and treatment outcome. Materials and methods. Data on 159 patients with severe multiple injuries, meeting inclusion criteria, were collected prospectively and evaluated retrospectively. Results. The mean age of multiple trauma patients was 43.9±1.4 years; males were injured 2.5 times more often than females (P<0.001). More than half (66.7%) of patients were 17–64-year-old males. Majority (83%) of all patients were injured in motor vehicle crashes, and 52.2% of these patients were pedestrians. The mean Injury Severity Score was 29.5±0.8, and severe (Abbreviated Injury Scale score of 3 and more) injuries of extremities, head, and chest made up 69.1% of all injuries. The mean ventilation time, mean length of stay in intensive care unit, and mean in-hospital stay were 5.5±0.7, 7.0±0.8, and 23.6±1.6 days, respectively. Acute lung complications were the most common (25.2%). Systemic inflammatory response syndrome developed in 7.5% of patients, and sepsis in 3.8% of patients. More than one-fifth (20.8%) of polytrauma patients died. Conclusions. Working-age male pedestrians (17–64 years old) made up two-thirds of all polytrauma patients. Severe injuries of extremities, head, and chest were present in 69.1% of all cases. Lung complications were the most common.

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The significance of a concomitant clavicle fracture in flail chest patients: incidence, concomitant injuries, and outcome of 12,348 polytraumata from the TraumaRegister DGU®

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01819-5 ◽

2021 ◽

Author(s):

Mustafa Sinan Bakir ◽

Andreas Langenbach ◽

Melina Pinther ◽

Rolf Lefering ◽

Sebastian Krinner ◽

...

Keyword(s):

Clavicle Fracture ◽

Flail Chest ◽

Spinal Column ◽

Rib Fractures ◽

Inclusion Criteria ◽

Concomitant Injuries ◽

Chest Injuries ◽

Thorax Trauma ◽

Hospital Stays ◽

Clavicle Fractures

Abstract Purpose Isolated clavicle fractures (CF) rarely show complications, but their influence in the thorax trauma of the seriously injured still remains unclear. Some authors associate CF with a higher degree of chest injuries; therefore, the clavicle is meant to be a gatekeeper of the thorax. Methods A retrospective analysis of the TraumaRegister DGU® (project 2017-10) was carried out involving the years 2009–2016 (ISS ≥ 16, primary admission to a trauma center). Cohort formation: unilateral and bilateral flail chest injuries (FC), respectively, with and without a concomitant CF. Results 73,141 patients (26.5% female) met the inclusion criteria and 12,348 had flail chest injuries (FC; 20.0% CF; 67.7% monolateral FC), 25,425 other rib fractures (17.7% CF), and 35,368 had no rib fractures (6.5% CF). On average, monolateral FC patients were 56.0 ± 17.9 years old and bilateral FC patients were 57.7 ± 19 years old. The ISS in unilateral and bilateral FC were 29.1 ± 11.7 and 42.2 ± 12.9 points, respectively. FC with a CF occurred more frequently with bicycle and motorbike injuries in monolateral FC and pedestrians in bilateral FC injuries and less frequently due to falls. Patients with a CF in addition to a FC had longer hospital and ICU stays, underwent artificially respiration for longer periods, and died less often than patients without a CF. The effects were highly significant in bilateral FC. CF indicates more relevant concomitant injuries of the lung, scapula, and spinal column. Moreover, CF was associated with more injuries of the extremities in monolateral CF. Conclusion Due to the relevance of a concomitant CF fracture in FC, diagnostics should focus on finding CFs or rule them out. Combined costoclavicular injuries are associated with a significantly higher degree of thoracic injuries and longer hospital stays.

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Management of traumatic flail chest in intensive care unit: An experience from trauma center ICU

Saudi Journal of Anaesthesia ◽

10.4103/sja.sja_699_18 ◽

2019 ◽

Vol 13 (3) ◽

pp. 179 ◽

Cited By ~ 1

Author(s):

Manjaree Mishra ◽

ShashiP Mishra ◽

Noor Bano ◽

MohammadZ Hakim

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Trauma Center ◽

Flail Chest

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Elimination of Routine Benzodiazepine Administration for Nonprocedural Sedation in a Trauma Intensive Care Unit is Feasible

The American Surgeon ◽

10.1177/000313481808400646 ◽

2018 ◽

Vol 84 (6) ◽

pp. 947-951

Author(s):

Kaitlin McGinn ◽

S. Noelle Davis ◽

Elizabeth Terrry ◽

Jon Simmons ◽

Sidney Brevard

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Injury Severity ◽

Care Service ◽

Current Guideline ◽

Mechanically Ventilated ◽

Light Levels ◽

Continuous Sedation ◽

Polytrauma Patients ◽

Level I

Current guidelines on the management of pain, agitation, and delirium in the intensive care unit (ICU) recommend a non-benzodiazepine (BDZ)–based approach to sedation. Management of agitation can be challenging in multitrauma patients but is imperative to facilitate patient recovery. Given the current guideline recommendations, a protocol to eliminate BDZ administration and maintain light levels of sedation was adopted in our ICU. The purpose of this analysis was to demonstrate that it is feasible to safely eliminate BDZ administration in a trauma ICU. This was a single-center, retrospective, observational analysis at a Level I trauma center. Adult patients (>18 years old) admitted to the Trauma Critical Care service from March 2015 to August 2015 were included. The primary outcome recorded was the use and duration of nonprocedural BDZs which was defined as BDZ not given within one hour of a procedure or test. A total of 64 patients met the inclusion criteria. The average Injury Severity Score was 18.7. A total of 14 patients (21.9%) received BDZ for a nonprocedure-related indication. Of those patients, all (100%) received less than three as-needed doses of BDZs during their ICU stay. In mechanically ventilated patients, continuous sedation or analgesia was not continued for more than 1.3 days. Only five patients (7.8%) received continuous BDZ. Limiting sedation is feasible in critically ill polytrauma patients. Protocols to standardize sedation strategies should be implemented in the ICU to avoid unnecessary sedation.

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Development of a visual analytics tool for polytrauma patients: Proof of concept for a new assessment tool using a multiple layer sankey diagram in a single-center database

British Journal of Surgery ◽

10.1093/bjs/znab202.050 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

C Niggli ◽

H -C Pape ◽

L Mica

Keyword(s):

Visual Analytics ◽

Trauma Center ◽

Injury Severity ◽

Assessment Tool ◽

Binary Logistic Regression ◽

Proof Of Concept ◽

Data Set ◽

Predictive Parameters ◽

Polytrauma Patients ◽

Level I

Abstract Objective Early physiological assessment of multiply injured patients is crucial for decision-making and has relied on personal experience of trauma experts. We have developed a new visual analytics tool (Sankey diagram, Watson Trauma Health care tool) that includes known prognostic parameters for polytrauma patients to help guide assessment and treatment decisions for physicians involved in trauma care. Methods A prospectively collected trauma database of a single level I trauma center (3655 patients) was used. Inclusion criteria: age > 16 years, an Injury Severity Score (ISS) > 16, and presence of a complete data set in the database. Data collected included admission values of patient age, injury scoring, shock classification, temperature, acid-base and hemostasis parameters. All of these parameters were collected daily as longitudinal parameters. Endpoints of the clinical course we considered were sepsis, SIRS and early in-hospital mortality (<72 hours). A proof of concept of the visualization was developed over a 2-year period in a cooperation between physicians and engineers. Statistically, the most predictive parameters were selected by binary logistic regression and ROC analysis. Results A dynamic interactive multi-layer Sankey diagram, based on cohort similarities, was developed in a collaboration between a level I trauma center and IBM, from August 2017 until January 2018. It is a modular tool and allows any user to add a new patient, or work with an existing case. The visualisation used the Data-Driven Documents (D3) interactive visualisation library to create a responsive graphic. Conclusion This application summarizes the experience of 3655 polytrauma patients and might serve as a guide for clinical decisions and educative purposes, as well as new scientific questions for the polytrauma patient.

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Complex open sternal fracture with impingement of the pericardium

Tropical Doctor ◽

10.1177/0049475520981264 ◽

2020 ◽

pp. 004947552098126

Author(s):

Sandeep Tiwari ◽

Anita Singh ◽

Paras Bhandari ◽

Debmoy Ghatak ◽

Harshit Agarwal

Keyword(s):

Respiratory Insufficiency ◽

Vertebral Fractures ◽

Cardiac Injury ◽

Flail Chest ◽

Rib Fractures ◽

Sternal Fracture ◽

Blunt Cardiac Injury ◽

Sternal Fractures

The incidence of sternal fracture ranges from 3 to 8%. In more than half, they are associated with other organ trauma such as blunt cardiac injuries, rib, scapular or vertebral fractures. Hence, the presence of sternal fracture is considered a marker for significant transmission of energy. The management of isolated sternal fractures is usually non-operative with surgery reserved for displaced fractures or in cases of respiratory insufficiency. However, management may become challenging when they are associated with other significant trauma. We discuss a case of sternal fracture complicated by the presence of blunt cardiac injury, open pneumothorax, rib fractures, anterior flail chest and empyema.

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Saúde ocupacional dos profissionais de enfermagem em unidade de terapia intensiva

Enfermagem em Foco ◽

10.21675/2357-707x.2013.v4.n2.525 ◽

2013 ◽

Vol 4 (2) ◽

pp. 115 ◽

Cited By ~ 1

Author(s):

Natasha Marques Frota ◽

Lívia Moreira Barros ◽

Luana Nunes Caldini ◽

Thiago Moura De Araújo ◽

Joselany Áfio Caetano

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Occupational Hazards ◽

Inclusion Criteria ◽

Occupational Risks ◽

Worker Health ◽

Final Sample ◽

Terapia Intensiva ◽

Health Nursing ◽

Nursing Professionals

Resumo: Objetivou-se identificar os riscos ocupacionais em profissionais de enfermagem em Unidade de Terapia Intensiva. Trata-se de uma revisão integrativa realizada no período de fevereiro a março de 2012. A amostra final do estudo contou com 12 artigos que atenderam os critérios de inclusão. Foi possível identificar que os riscos ocupacionais mais presentes na UTI estão associados aos riscos de acidentes, seguido do biológico, químico e ergonômico. Frente a esta realidade é necessário a implementação de medidas para a prevenção dos riscos, para diminuição do absenteísmo e a promoção da saúde do trabalhador de enfermagem.Palavras-Chave: Enfermagem do trabalho, Riscos ocupacionais, Unidades de Terapia Intensiva.Occupational health of nurses in the Intensive Care UnitAbstract: This study aimed to identify occupational hazards in nursing professionals in the Intensive Care Unit. It is an integrative review carried out during February-March 2012. The final sample included 12 articles that met the inclusion criteria. It was possible to identify the occupational hazards present in the ICU are more associated with the risk of accidents, followed by biological, chemical and ergonomic. Faced with this reality is necessary to implement measures to prevent risks, to reduce absenteeism and promote worker health nursing.Keywords: Occupational Health Nursing, Occupational Risks, Intensive Care Units.Salud en el trabajo de las enfermeras en la Unidad de Cuidados IntensivosResumen: Este estudio tuvo como objetivo identificar los riesgos laborales en los profesionales de enfermería en la Unidad de Cuidados Intensivos. Se trata de una revisión integradora llevada a cabo durante febrero y marzo de 2012. La muestra final incluyó 12 artículos que cumplieron los criterios de inclusión. Fue posible identificar los riesgos laborales presentes en la UCI son más asociado con el riesgo de accidentes, seguido por agentes biológicos, químicos y ergonómicos. Frente a esta realidad es necesario aplicar medidas para prevenir los riesgos, para reducir el absentismo y fomentar la enfermería profesional de la salud.Palabras Clave: Enfermería del Trabajo, Riesgos Laborales, Unidades de Cuidados Intensivos.

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Prehospital time and mortality in polytrauma patients: a retrospective analysis

BMC Emergency Medicine ◽

10.1186/s12873-021-00476-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

E. Berkeveld ◽

Z. Popal ◽

P. Schober ◽

W. P. Zuidema ◽

F. W. Bloemers ◽

...

Keyword(s):

Patient Outcome ◽

Emergency Medical Services ◽

Trauma Center ◽

Total Mortality ◽

Medical Services ◽

Severely Injured ◽

Emergency Medical ◽

Polytrauma Patients ◽

Level I ◽

Prehospital Time

Abstract Background The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center. Methods A retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality. Results In total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively (p = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality (p = 0.156). Conclusion This analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.

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Endothelial glycocalyx degradation is associated with early organ impairment in polytrauma patients

BMC Emergency Medicine ◽

10.1186/s12873-021-00446-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Feng Qi ◽

Hao Zhou ◽

Peng Gu ◽

Zhi-He Tang ◽

Bao-Feng Zhu ◽

...

Keyword(s):

Injury Severity ◽

Early Stage ◽

Endothelial Glycocalyx ◽

Control Group ◽

Metabolic System ◽

Metabolic Systems ◽

Organ Systems ◽

Severity Scores ◽

Polytrauma Patients ◽

Trauma Group

Abstract Background Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in polytrauma patients. Methods A prospective observational study was conducted to enroll health participants (control group) and polytrauma patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 h and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 h, and 28-day mortality in trauma group. Results There were 45 polytrauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P < 0.001, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. The area under the receiver operator characteristic curves (AUC) of SDC1 to predict AKI, TIC occurrence within 48 h and 28-day mortality were 0.838 (95%CI: 0.720–0.957), 0.700 (95%CI: 0.514–0.885) and 0.764 (95%CI: 0.543–0.984), respectively. Conclusions EG degradation was elevated significantly in polytrauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems in early stage. Serum SDC1 is a valuable predictive indicator of early onset of AKI, TIC, and 28-day mortality in polytrauma patients.

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Operative Treatment of Severe Cervical Spine Injuries Sustained in Youth Sports: Experience from a Pediatric Level 1 Trauma Center over a 16-Year Period

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00085 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0008

Author(s):

Bram P Verhofste ◽

Daniel J Hedequist ◽

Craig M Birch ◽

Emily S Rademacher ◽

Michael P Glotzbecker ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Trauma Center ◽

Youth Sports ◽

Axial Loading ◽

Permanent Disability ◽

Cervical Spine Injuries ◽

Cord Injury ◽

Spine Injuries ◽

Level 1

Background: Sports-related cervical spine injuries (CSI) are devastating traumas with the potential for permanent disability. There is a paucity of literature on operative CSI sustained in youth athletes. Hypothesis/Purpose: The aims of this study aims were to review injury characteristics, surgical treatment, and outcomes of severe pediatric CSI encountered in youth sports. Methods: We reviewed children less than 18 years old with operative sports-related CSI at a pediatric Level 1 pediatric trauma center between 2004−2019. All cases underwent modern cervical spine instrumentation and fusion. SCI were stratified according to the American Spinal Injury Association Impairment Scale (ASIA). Clinical, radiographic, and surgical characteristics were compared between groups of patients with and without spinal cord injury (SCI). Results: Three thousand two hundred and thirty-one children (mean, 11.3y±4.6y) were evaluated for CSI at our institution during the 16-year period. The majority of traumas resulted from sports/recreational activities and were seen in 1365 cases (42.3%). Of these, 171/1365 patients (12.5%) were admitted and 29/1365 patients (2.1%) required surgical intervention (mean age, 14.5y±2.88y; range, 6.4y–17.8y). Sports included: eight football (28%), seven wrestling (24%), five gymnastics (17%), four diving (14%), two trampoline (7%), one hockey (3%), one snowboarding (3%), and one biking injury (3%). Mechanisms were 19 hyperflexion (65%), eight axial loading (28%), and two hyperextension injuries (7%). The majority of operative CSI were fractures (79%) and/or subaxial defects (72%). Seven patients (30%) sustained SCI and three patients (10%) spinal cord contusion or myelomalacia without neurologic deficits. The risk of SCI increased with age (15.8y vs. 14.4y; p=0.03) and axial loading mechanism (71% vs. 14%; p=0.003). Postoperatively, two SCI patients (29%) improved 1 ASIA Grade and one (14%) improved 2 ASIA Grades. Increased complications developed in SCI than patients without SCI (mean, 2.0 vs 0.1 complications; p=0.02). Clinical and radiographic fusion occurred in 24/26 patients (92%) with adequate follow-up (median, 32 months). Ten patients returned to their previous activity and nine to sports with a lower level of activity. Conclusion: The overall incidence of sports-related operative CSI is low. Age- and gender discrepancies exist, with male adolescent athletes most commonly requiring surgery. Hyperflexion injuries had a good prognosis; however, older males with axial loading CSI sustained in contact sports were at greatest risk of SCI, complications, and permanent disability. [Figure: see text][Table: see text][Table: see text]

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