Clinical Outcome of Urgent Thoracotomy in Patients with Penetrating and Blunt Chest Trauma: A Retrospective Survey

Introduction In contrast to an emergency department of thoracotomy (EDT), an urgent thoracotomy (UT) is defined as a surgical thoracic intervention performed in the operating room within the first 48 hours of the patient's intensive care unit (ICU) stay. The factors affecting survival after UT are not fully understood. In this study, we retrospectively analyzed the clinical data and outcome of patients with blunt and penetrating chest injuries who underwent UT. Methods All adult patients who had blunt or penetrating chest trauma and who underwent UT, were included in the study. All data were collected from the patients' hospital and ICU records. Forty-five patients with thoracic injuries who underwent UT during the first 48 hours of ICU stay were analyzed. Of these, 25 had penetrating chest injuries, and 20 had blunt thoracic injuries. Of the penetrating injuries, 16 were stab wounds, and 9 were gunshot wounds. Results Overall ICU mortality was 29% (n = 13) and was significantly higher in the blunt chest trauma group than in the penetrating trauma group (45% vs 16%; p = 0.04). Lung parenchyma injuries (lacerations and contusions) were the most common intraoperative findings in both groups. The following independent predictors of in-hospital mortality were found: an Injury Severity Score (ISS) of >40; an Acute Physiology and Chronic Evaluation II (APACHE II) score of >30; prolonged duration of UT; low body temperature on admission to the ED; abnormal arterial blood lactate, bicarbonate, and pH at the end of UT; and use of vasopressors during the first 24 hours of ICU stay. Conclusion Mortality after UT was higher in patients with blunt chest trauma. The UT should be performed in both penetrating and blunt chest trauma as quickly as possible and should be limited to damage control. It also emerges that acidosis and hypothermia in chest trauma patients need to be treated extremely aggressively before, during, and after UT.

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Perils of Rib Fractures

The American Surgeon ◽

10.1177/000313480807400406 ◽

2008 ◽

Vol 74 (4) ◽

pp. 310-314 ◽

Cited By ~ 30

Author(s):

Om P. Sharma ◽

Michael F. Oswanski ◽

Shashank Jolly ◽

Sherry K. Lauer ◽

Rhonda Dressel ◽

...

Keyword(s):

Elderly Patients ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Injury Severity ◽

Motor Vehicle ◽

Rib Fractures ◽

Trauma Patients ◽

Close Observation ◽

Motorcycle Crashes ◽

Level 1 Trauma Center

Rib fractures (RF) are noted in 4 to 12 per cent of trauma admissions. To define RF risks at a Level 1 trauma center, investigators conducted a 10-year (1995–2004) retrospective analysis of all trauma patients. Blunt chest trauma was seen in 13 per cent (1,475/11,533) of patients and RF in 808 patients (55% blunt chest trauma, 7% blunt trauma). RF were observed in 26 per cent of children (<18 years), 56 per cent of adults (18–64 years), and 65 per cent of elderly patients (≥65 years). RF were caused by motorcycle crashes (16%, 57/347), motor vehicle crashes (12%, 411/3493), pedestrian-auto collisions (8%, 31/404), and falls (5%, 227/5018). Mortality was 12 per cent (97/808; children 17%, 8/46; adults 9%, 46/522; elderly 18%, 43/240) and was linearly associated with a higher number of RF (5% 1–2 RF, 15% 3–5 RF, 34% ≥6 RF). Elderly patients had the highest mortality in each RF category. Patients with an injury severity score ≥15 had 20 per cent mortality versus 2.7 per cent with ISS <15 ( P < 0.0001). Increasing age and number of RF were inversely related to the percentage of patients discharged home. ISS, age, number of RF, and injury mechanism determine patients’ course and outcome. Patients with associated injuries, extremes of age, and ≥3 RF should be admitted for close observation.

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The Abdominal Reapproximation Anchor Device

Surgical Innovation ◽

10.1177/1553350616671640 ◽

2016 ◽

Vol 24 (1) ◽

pp. 49-54 ◽

Cited By ~ 3

Author(s):

Alfin Okullo ◽

Mehan Siriwardhane ◽

Tony C. Y. Pang ◽

Jane-Louise Sinclair ◽

Vincent W. T. Lam ◽

...

Keyword(s):

Best Practice ◽

Open Abdomen ◽

Damage Control ◽

Case Series ◽

Penetrating Trauma ◽

Apache Ii ◽

Fascial Closure ◽

Apache Ii Score ◽

Skin Closure ◽

Icu Stay

Introduction. Achieving primary fascial closure after damage control laparostomy can be challenging. A number of devices are in use, with none having yet emerged as best practice. In July 2013, at Westmead Hospital, we started using the abdominal reapproximation anchor (ABRA; Canica Design, Almonte, Ontario, Canada) device. We report on our experience. Methods. A retrospective review of medical records for patients who had open abdomens managed with the ABRA device between July to December 2013 was done. Data extracted included age, sex, body mass index (BMI), reason for the open abdomen, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, number of laparostomies prior to ABRA placement, duration of placement, device complications, length of hospital and intensive care unit (ICU) stay, and outcomes. Results. Four cases of open abdomens managed using the ABRA device were identified, with 3 a consequence of intra-abdominal sepsis and 1 a consequence of penetrating trauma. Mean BMI was 33.5 kg/m2, APACHE II score was 14.5, duration with open abdomen prior to ABRA placement was 11.75 days, duration with ABRA in situ was 9 days, duration of hospital stay was 64.25 days, and ICU stay was 37.75 days. Three patients (75%) achieved fascial closure, and 1 achieved skin closure. No incidences of enterocutaneous fistulae occurred. Conclusion. The ABRA is a unique emerging alternative to aid in achieving fascial closure in patients managed with open abdomens. Our case series demonstrates that it can be used effectively in selected patients. Studies are needed to compare its efficacy with more traditional methods.

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Delayed Respiratory Failure After Blunt Chest Trauma

The American Surgeon ◽

10.1177/0003134820966278 ◽

2020 ◽

pp. 000313482096627

Author(s):

Christina S. Martin ◽

Ning Lu ◽

David S. Inouye ◽

Kazuma Nakagawa ◽

Karen Ng ◽

...

Keyword(s):

Respiratory Failure ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Injury Severity ◽

Rib Fractures ◽

P Value ◽

Clinical Predictors ◽

Chi Square ◽

Risk Patients ◽

Student’S T

Background Patient factors associated with delayed respiratory failure (DRF) after blunt chest trauma are not well documented. Earlier identification and closer monitoring may improve outcomes for these patients. The purpose of this study was to identify the prevalence and clinical predictors of DRF in patients after blunt chest trauma. Materials and Methods A retrospective review of adult patients admitted to a Level 1 trauma center after blunt chest trauma between January 1, 2009 and December 31, 2013, was conducted. Patients with early respiratory failure were compared to patients with DRF using Fisher’s exact tests, chi square, and Student’s t-tests. A P-value of <.05 was considered significant. Results 1299 patients had blunt chest trauma and at least 1 rib fracture, of which 830 met inclusion criteria. 5.8% of patients progressed to respiratory failure. Respiratory failure was delayed in 25% of these patients. DRF patients had significantly lower ISS (16.5 vs. 22.7, P = .04), more bilateral rib fractures (66.7% vs. 28.7%, P = .02) and fewer pulmonary contusions (16.7% vs. 50.0%, P = .04). Discussion Injury patterns, including bilateral rib fractures without pulmonary contusions and low but severe Injury Severity Score burden, may help identify high-risk patients who may benefit from closer monitoring and more aggressive therapy.

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Hyperoxemia in postsurgical sepsis/septic shock patients is associated with reduced mortality

Critical Care ◽

10.1186/s13054-021-03875-0 ◽

2022 ◽

Vol 26 (1) ◽

Author(s):

Marta Martín-Fernández ◽

María Heredia-Rodríguez ◽

Irene González-Jiménez ◽

Mario Lorenzo-López ◽

Estefanía Gómez-Pesquera ◽

...

Keyword(s):

Septic Shock ◽

Prolonged Mechanical Ventilation ◽

Treatment Strategies ◽

Major Surgery ◽

Apache Ii Score ◽

Shock Onset ◽

Icu Patients ◽

Risk Of Death ◽

Icu Stay ◽

Arterial Blood

Abstract Background Despite growing interest in treatment strategies that limit oxygen exposure in ICU patients, no studies have compared conservative oxygen with standard oxygen in postsurgical patients with sepsis/septic shock, although there are indications that it may improve outcomes. It has been proven that high partial pressure of oxygen in arterial blood (PaO2) reduces the rate of surgical-wound infections and mortality in patients under major surgery. The aim of this study is to examine whether PaO2 is associated with risk of death in adult patients with sepsis/septic shock after major surgery. Methods We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups whether they had hyperoxemia, defined as PaO2 > 100 mmHg (n = 216), or PaO2 ≤ 100 mmHg (n = 238) at the day of sepsis/septic shock onset according to SEPSIS-3 criteria maintained during 48 h. Primary end-point was 90-day mortality after diagnosis of sepsis. Secondary endpoints were ICU length of stay and time to extubation. Results In patients with PaO2 ≤ 100 mmHg, we found prolonged mechanical ventilation (2 [8] vs. 1 [4] days, p < 0.001), higher ICU stay (8 [13] vs. 5 [9] days, p < 0.001), higher organ dysfunction as assessed by SOFA score (9 [3] vs. 7 [5], p < 0.001), higher prevalence of septic shock (200/238, 84.0% vs 145/216) 67.1%, p < 0.001), and higher 90-day mortality (37.0% [88] vs. 25.5% [55], p = 0.008). Hyperoxemia was associated with higher probability of 90-day survival in a multivariate analysis (OR 0.61, 95%CI: 0.39–0.95, p = 0.029), independent of age, chronic renal failure, procalcitonin levels, and APACHE II score > 19. These findings were confirmed when patients with severe hypoxemia at the time of study inclusion were excluded. Conclusions Oxygenation with a PaO2 above 100 mmHg was independently associated with lower 90-day mortality, shorter ICU stay and intubation time in critically ill postsurgical sepsis/septic shock patients. Our findings open a new venue for designing clinical trials to evaluate the boundaries of PaO2 in postsurgical patients with severe infections.

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Frequency and importance of blush in lung contusion in patients with blunt trauma: A retrospective observational study

10.21203/rs.3.rs-168724/v1 ◽

2021 ◽

Author(s):

Naoki Tominaga ◽

Mineji Hayakawa ◽

Shoji Yokobori

Keyword(s):

Observational Study ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Injury Severity ◽

University Hospital ◽

Lung Contusion ◽

Retrospective Observational Study ◽

Splenic Trauma ◽

Trauma Severity ◽

Enhanced Computed Tomography

Abstract Background: The high mortality rate in patients with blunt chest trauma remains a problem. The assessment of blush in hepatic and splenic trauma is important because it indicates the need for emergency hemostatic intervention. However, the frequency and importance of blush in lung contusions are unknown. Therefore, this study aimed to evaluate the frequency of blush in the lung contusion and the relationship between blush and the clinical outcome of patients with blunt chest trauma.Methods: In this retrospective observational study, we enrolled patients with an injury severity score of 16 or higher and a chest abbreviated injury scale of 3 or higher who were admitted to the emergency department of Hokkaido University Hospital from January 1, 2003, to December 31, 2016. Blush was defined as an active extravasation image of an intravascular contrast agent recognized on contrast-enhanced computed tomography. Date of trauma severity, various treatments, and outcomes were recorded from the electrical medical records of the patients.Results: During the study period, 83 patients had severe lung contusions and 12 patients had blush. In-hospital mortality of patients with blush was significantly higher than that of patients without blush. Patients with blush required support through mechanical ventilation more frequently and for a longer duration than patients without blush.Conclusion: Our study revealed that blush in the lung contusions was not rare and was associated with a high risk of mortality in patients with severe blunt chest trauma. We should not hesitate to intervene if a blush of the lung contusion was detected in a patient with blunt chest trauma.

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Comparison of Multiplane Transesophageal Echocardiography and Contrast-enhanced Helical CT in the Diagnosis of Blunt Traumatic Cardiovascular Injuries

Anesthesiology ◽

10.1097/00000542-200104000-00015 ◽

2001 ◽

Vol 94 (4) ◽

pp. 615-622 ◽

Cited By ~ 77

Author(s):

Philippe Vignon ◽

Marie-Paule Boncoeur ◽

Bruno François ◽

Geoffray Rambaud ◽

Antoine Maubon ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Transesophageal Echocardiography ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Injury Severity ◽

Innominate Artery ◽

Helical Ct ◽

Aortic Injury ◽

Helical Computed Tomography ◽

Aortic Isthmus

Background Multiplane transesophageal echocardiography (TEE) and helical computed tomography (CT) of the chest have been validated separately against aortography for the diagnosis of acute traumatic aortic injuries (ATAI). However, their respective diagnostic accuracy in identifying blunt traumatic cardiovascular lesions has not been compared. Methods During a 3-yr period, 110 consecutive patients with severe blunt chest trauma (age: 41 +/- 17 yr; injury severity score: 34 +/- 14) prospectively underwent TEE and chest CT as part of their initial evaluation. Results of both imaging methods were interpreted independently by experienced investigators and subsequently compared. All cases of subadventitial acute traumatic aortic injury were surgically confirmed. Results Seventeen patients had vascular injury and 11 had cardiac lesions. TEE and CT identified all subadventitial disruptions involving the aortic isthmus (n = 10) or the ascending aorta (n = 1) that necessitated surgical repair. In contrast, CT only depicted one disruption of the innominate artery. TEE detected injuries involving the intimal or medial layer, or both, of the aortic isthmus in four patients with apparently normal CT results who underwent successful conservative treatment. All cardiac injuries but two were identified only by TEE. Conclusions In patients with severe blunt chest trauma, TEE and CT have similar diagnostic accuracy for the identification of surgical acute traumatic aortic injuy. TEE also allows the diagnosis of associated cardiac injuries and is more sensitive than CT for the identification of intimal or medial lesions of the thoracic aorta.

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Epidemiological and clinical characteristics of road traffic crashes related thoracic traumas: analysis of 5095 hospitalized chest injury patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01599-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Shengcao Zhang ◽

Xiangzhi Xiao ◽

Jian Wang ◽

Chengkai Hu ◽

Qiancheng Du ◽

...

Keyword(s):

Clinical Characteristics ◽

Injury Severity ◽

Road Traffic ◽

Rib Fractures ◽

Motor Vehicles ◽

Trauma Patients ◽

Thoracic Injuries ◽

Traffic Crashes ◽

Road Traffic Crashes ◽

Chest Injuries

Abstract Background Road traffic crashes related (RTCR) chest traumas remain important global public health challenge. The impact of boosting market of automobile vehicles in China during last decade on thoracic injury needs to be defined. This study aimed to review and analyze the demographic and clinical characteristics of RTCR thoracic injuries in China. Methods Clinical records of patients with thoracic trauma admitted to thoracic surgery department between January 2003 and June 2020 were retrospectively retrieved and reviewed. Patients’ profiles and clinical characteristics were comparatively analyzed between road traffic crashes caused injury and other injury mechanisms, and in RTCR chest trauma patients before January 2011 (2003 group), and after January 2011 (2011 group), when is considered as the beginning year of Chinese household vehicle era. Results The study included 5095 thoracic trauma patients with mean age of 50.2 years, of whom 79.4% were male. Most of the patients (70.3%, n = 3583) had rib fractures. Associated injuries were present in 52.0% of the patients, of them 78.5% (n = 2080) were extremity fractures. Road traffic crashes accounted for 41.4% (n = 2108) of the injuries, most of them (98.0%) were related to motor vehicles. In comparison with other chest trauma mechanisms, RTCR chest injuries affected females and older males more frequently, with a higher incidence of rib fractures and sternum fractures, and higher injury severity scores (ISS) (all p < 0.05). Surgeries were required in 1495 (70.9%) patients of the RRTCR chest traumas, while the majority of non-RTCR thoracic injuries were managed conservatively or with tube thoracostomy (30.2%, n = 901). RTCR chest traumas caused longer hospital stay (13.0 ± 9.6 days vs. 11.8 ± 7.4 days, p = 0.001), higher ICU usage (30.7% vs. 19.6%, p = 0.001), higher rate of ventilator support (12.9% vs. 7.5%, p = 0.001), and higher mortalities (3.8% vs. 1.6%, p = 0.005) than that of non-RTRA chest injuries. For RTCR patients, when compared with 2003 group, 2011 group had similar patterns in terms of accident category, associated injury and treatment. However, 2011 group had more females (38.5% vs. 18.0%, p = 0.001) and older males (50.6 ± 9.7 vs. 47.9 ± 17.2, p = 0.001), with a higher ISS (18.3 ± 10.2 vs. 17.1 ± 8.9, p = 0.004), and fewer were managed with chest tubes (25.0% vs. 29.2%, p = 0.031). Clinical outcomes were not significantly different between the groups in terms of hospital length of stay, intensive care unit (ICU) usage, ICU length of stay, duration of ventilator hours and mortality. However, the 2011 group had more patients requiring ventilator support (14.4% vs. 10.6%, p = 0.011). Conclusions Road traffic crashes remain to be the major etiology of thoracic injuries in China, which usually affects middle-aged males, causing rib fractures with concomitant injuries frequently occurring to other organ systems. Treatments mainly include tube thoracotomy and surgical procedures. Although the clinical characteristics and outcomes of traffic accident related chest traumas are largely unchanged in spite of the rapid increasing numbers of motor vehicles, variations in the pattern of injuries by gender, age, injury severity and ventilator usage may still provide important information for targeted management.

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Hemostasis and inflammation in patients with polytrauma

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.8.2021.245580 ◽

2021 ◽

Vol 17 (8) ◽

pp. 66-72

Author(s):

O.V. Filyk ◽

M.B. Vyshynska

Keyword(s):

Intensive Care ◽

Health Status ◽

Body Temperature ◽

Injury Severity ◽

Inverse Correlation ◽

Apache Ii ◽

Apache Ii Score ◽

Positive Correlation ◽

Icu Stay ◽

Length Of Icu Stay

Background. Causes of death due to severe injuries are both injuries incompatible with life and severe bleedings. Trauma-induced coagulopathy is usually found in 46 % of patients at the scene and in 60 % of individuals upon admission to the hospital. The purpose of the study was to establish the relationship between systemic inflammatory response syndrome (SIRS) and vascular-platelet and coagulation hemostasis parameters in patients with polytrauma. Materials and methods. We completed a prospective observational study and included 20 patients aged 19 to 55 years with polytrauma who were admitted to the Department of Anesthesiology with Intensive Care at Lviv City Clinical Hospital No. 8. Patients’ state was evaluated according to the Injury Severity Score (ISS) and Acute Physiology and Chronic Health Evaluation (APACHE II) score. We also took into account the duration of SIRS, the length of intensive care unit (ICU) stay, and hospital stay. Stages of the study: the day of admission to ICU (d1), the third day (d3), the fifth day (d5). The major clinical markers evaluated were: SIRS parameters, vascular-platelet hemostasis (intravascular platelet activation, adrenaline- and adenosine diphosphate-induced platelet aggregation), coagulation hemostasis (international normalized ratio, activated partial thromboplastin time, level of total fibrinogen and D-dimers). Statistical analysis was performed using variation statistics methods. The correlation dependence was performed with Spearman’s rank correlation coefficient. We determined significance level (p), and the differences were considered statistically significant at p < 0.05. Results. We have found a significant (p < 0.05) positive correlation between discocytes to spherocytes ratio and the level of total fibrinogen on stage d1, as well as a tendency (p = 0.09) to the presence of a positive correlation between this ratio and the patient’s body temperature. There was a significant (p < 0.05) inverse correlation between this ratio and the patient’s health status according to APACHE II, and a direct significant (p < 0.05) correlation with the length of ICU stay, as well as trends to an inverse correlation with the severity of injuries according to ISS (p = 0.07) and to a direct correlation with the duration of SIRS (p = 0.12). Conclusions. Patients with polytrauma had a significant (p < 0.05) positive correlation between the discocytes to spherocytes ratio and level of total fibrinogen, a tendency (p = 0.09) to a positive correlation between this ratio and the patient’s body temperature, a significant (p < 0.05) inverse correlation with the patient’s health status according to APACHE II, a direct significant (p < 0.05) correlation with the length of ICU stay, a trend (p = 0.07) to an inverse correlation with the severity of injuries according to ISS and a tendency (p = 0.12) to a direct correlation with duration of SIRS.

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The effect of aerosolized indomethacin on lung inflammation and injury in a rat model of blunt chest trauma

Canadian Journal of Surgery ◽

10.1503/cjs.014318 ◽

2018 ◽

pp. S208-S218

Author(s):

Raymond L. Kao ◽

Weixiong Huang ◽

Claudio M. Martin ◽

Tao Rui

Keyword(s):

Inflammatory Response ◽

Rat Model ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Sham Group ◽

Histopathological Analysis ◽

Sprague Dawley ◽

Tissue Samples ◽

Arterial Blood Gas ◽

Arterial Blood

Background: Acute lung contusion from blunt chest trauma (BCT) is characterized by an intense inflammatory response in the pulmonary parenchyma, which is associated with acute lung injury (ALI), acute respiratory distress syndrome and ventilator-associated pneumonia. We hypothesized that aerosolized indomethacin may reduce pulmonary inflammation and ALI in a rat model of BCT. Methods: Sprague-Dawley rats were anesthetized and received a tracheotomy for administration of aerosolized medication through a catheter. The BCT procedure involved free-dropping a hollow metal weight (200 g) from a height of 25.5, 38.3 or 51.2 cm onto the right thorax. We administered 1 mg/kg of indomethacin or 1 mL/kg of saline intratracheally 15 minutes after BCT. The sham group had a similar procedure without the exposure to BCT and treatment. Three hours postimpact, we obtained arterial blood gas and analyzed bronchoalveolar lavage for protein concentration, polymorphonuclear leukocytes (PMN) and cytokine levels, and lung tissue samples were taken for histopathological analysis. Results: The rats’ mean arterial pressure and heart rate dropped immediately postimpact but recovered close to that of the sham group after 30 minutes in both control and treatment groups. Compared to BCT alone, indomethacin significantly reduced the total protein level in the lungs (1.06 ± 0.39 mg/mL v. 3.75 ± 1.95 mg/mL, p = 0.006) and alveolar FD-70 leak (0.23 ± 0.19 μg/mL v. 0.53 ± 0.19 μg/mL, p = 0.02). Indomethacin also significantly attenuated the acute inflammatory response in percent PMN (13.33 ±7.5% v. 28.0 ± 12.96%, p = 0.04). Tumour necrosis factor-α and interleukin-6 decreased in the indomethacin group, but the decreases were not significant compared with other groups. Conclusion: Aerosolized indomethacin has a protective effect against alveloar tissue permeability and inflammatory response induced by BCT.

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Risk Factors Associated with Venous Thromboembolism in Isolated Blunt Chest Trauma

The American Surgeon ◽

10.1177/000313481307900526 ◽

2013 ◽

Vol 79 (5) ◽

pp. 502-505 ◽

Cited By ~ 3

Author(s):

Steven A. Kahn ◽

Heidi Schubmehl ◽

Nicole A. Stassen ◽

Ayodele Sangosanya ◽

Julius D. Cheng ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Venous Thromboembolism ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Injury Severity ◽

Aortic Injury ◽

Chest Injury ◽

Hospital Length Of Stay ◽

Thoracic Injury

Isolated chest trauma is not historically considered to be a major risk factor for venous thromboembolism (VTE). After blunt chest trauma, VTE may be underappreciated because pain, immobility, and inadequate prophylaxis as a result of hemorrhage risk may all increase the risk of VTE. This investigation determines the predictors and rate of VTE after isolated blunt chest trauma. A review of patients admitted to a Level I trauma center with chest trauma between 2007 and 2009 was performed. Demographics, injuries, VTE occurrence, prophylaxis, comorbidities, Injury Severity Score, intensive care unit/hospital length of stay, chest tube, and mechanical ventilation use were recorded. VTE rate was compared between those with isolated chest injury and those with chest injury plus extrathoracic injury. Predictors of VTE were determined with regression analysis. Three hundred seventy patients had isolated chest trauma. The incidence of VTE was 5.4 per cent (n = 20). The VTE rate in those with chest injury plus extrathoracic injury was not significantly different, 4.8 per cent (n = 56 of 1140, P = 0.58). Independent risk factors for VTE after isolated chest trauma were aortic injury ( P < 0.01, odds ratio [OR], 47.7), mechanical ventilation ( P < 0.01; OR, 6.8), more than seven rib fractures ( P < 0.01; OR, 6.1), hemothorax ( P < 0.05; OR, 3.9), hypercoagulable state ( P < 0.05; OR, 6.3), and age older than 65 years ( P < 0.05; OR, 1.03). Patients with the risk factors mentioned are at risk for VTE despite only having thoracic injury and might benefit from more aggressive surveillance and prophylaxis.

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