Associated Injuries in Traumatic Sternal Fractures: A Review of the National Trauma Data Bank

2013 ◽  
Vol 79 (7) ◽  
pp. 702-705 ◽  
Author(s):  
Tolulope A. Oyetunji ◽  
Hope T. Jackson ◽  
Augustine C. Obirieze ◽  
Danier Moore ◽  
Marc J. Branche ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Cardiac Injury ◽  
Data Bank ◽  
Motor Vehicle Crash ◽  
Associated Injuries ◽  
Severe Injuries ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Sternal Fractures

Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures. The demographics were analyzed by age, gender, mechanism and indicators of anatomic and physiologic injuries. Types of commonly associated injuries were also determined. A total of 23,985 records were analyzed. Males accounted for 68.3 per cent and whites 70.9 per cent. Motor vehicle crash was the leading mechanism. More than 56 per cent had severe injuries based on Injury Severity Score (greater than 15) and 17 per cent with Glasgow Coma Score 8 or less. Crude mortality was 7.9 per cent. The majority (57.8%) and approximately one-third (33.7%) of the patients had rib fractures and lung contusions, respectively, 22.0 per cent with closed pneumothorax, 21.6 per cent had a closed thoracic vertebra fracture, 16.9 per cent with lumbar spine fracture, 3.9 per cent with concussion, and blunt cardiac injury in 3.6 per cent. Sternal fractures are usually associated with severe blunt trauma. Lung contusion remains the leading associated injury followed by vertebral spine fractures. Cardiac injuries are less frequent and vascular injuries less so. Mechanism of injury and presence of sternal fractures should alert providers to these potential associated injuries.

Seatbelt use is associated with lower risk of high-grade hepatic injury in motor vehicle crashes in a national sample

2018 ◽  
Vol 72 (8) ◽  
pp. 746-751 ◽  
Author(s):  
Audrey Renson ◽  
Brynne Musser ◽  
Finn D Schubert ◽  
Marc A Bjurlin
Keyword(s):  
Liver Injury ◽  
Lower Risk ◽  
Hepatic Injury ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Data Bank ◽  
Motor Vehicle Crashes ◽  
Protective Devices ◽  
National Trauma ◽  
National Trauma Data Bank

BackgroundSeatbelt use, alone and in conjunction with an airbag, is associated with lower risk of mortality, blunt abdominal trauma and kidney injury in motor vehicle crashes (MVCs). However, the effect of these protective devices on risk of severe liver injury is not well characterised.MethodsThis retrospective cohort study included patient admissions with liver injuries from MVCs from the National Trauma Data Bank (NTDB), collected from 2010 to 2015 in the USA. We examined associations between injury severity and seatbelt use and airbag presence individually and in the presence of additive interaction. Secondary outcomes were mortality, complications and discharge disposition.ResultsWe analysed 55 543 records from the National Trauma Data Bank. In adjusted analysis, seatbelt use alone was protective against severe (AAST VI or above) hepatic injury (risk ratio (RR) 0.79, 95% CI 0.75 to 0.84), while airbag presence alone was not (RR 1.05, 95% CI 0.8 to 1.12). The joint association of seatbelt use and airbag presence with injury severity was greater than seatbelts alone (RR 0.74, 95% CI 0.70 to 0.79), with 13% of the joint lower risk attributable to interaction (95% CI 3% to 24%). The adjusted mortality risk of those without protective devices (10.3%, n=2297) was nearly double that of patients who used a seatbelt in conjunction with a present airbag (5.3%, n=699, p<0.001).ConclusionsSeatbelts are associated with lower liver injury severity and are more protective with airbags present, while airbags without seatbelt use were not protective against severe injury among patients with liver injury.

Helicopter Transport Use for Trauma Patients Is Decreasing Significantly Nationwide but Remains Overutilized

2018 ◽  
Vol 84 (10) ◽  
pp. 1630-1634 ◽  
Author(s):  
Navpreet K. Dhillon ◽  
Nikhil T. Linaval ◽  
Kavita A. Patel ◽  
Christos Colovos ◽  
Ara Ko ◽  
...  
Keyword(s):  
Injury Severity ◽  
Data Bank ◽  
The United States ◽  
Trauma Patients ◽  
Effective Utilization ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Minor Injuries ◽  
Helicopter Transportation ◽  
Rapid Transfer

Rapid transfer of trauma patients to a trauma center for definitive management is essential to increase survival. The utilization of helicopter transportation for this purpose remains heavily debated. The purpose of this study was to characterize the trends in helicopter transportations of trauma patients in the United States over the last decade. Subjects with a primary mode of either ground or helicopter transportation were selected from the National Trauma Data Bank datasets 2007 to 2015. Over this period, the proportion of patients transported by a helicopter decreased significantly in a linear fashion from 17 per cent in 2007 to 10.2 per cent in 2015 ( P < 0.001). The overall mortality of this population was 7.6 per cent and remained unchanged over the study period ( P = 0.545). Almost 3 of 10 subjects (29.4%) transported by a helicopter had an Injury Severity Score <9. The proportion of elderly (>65 years) patients requiring helicopter transportation increased by 69.1 per cent, whereas their associated mortality decreased by 21.5 per cent. The use of a helicopter for the transportation of trauma patients has significantly decreased over the last decade without any significant change in mortality, possibly indicating more effective utilization of available resources. Overtriage of patients with minor injuries remained relatively unchanged.

Sternal fractures in children: An analysis of the National Trauma Data Bank

2019 ◽  
Vol 54 (5) ◽  
pp. 980-983 ◽  
Author(s):  
Eric H. Rosenfeld ◽  
Patricio Lau ◽  
Sohail R. Shah ◽  
Bindi Naik-Mathuria ◽  
David E. Wesson ◽  
...  
Keyword(s):  
Data Bank ◽  
National Trauma ◽  
Fractures In Children ◽  
National Trauma Data Bank ◽  
Sternal Fractures

Farm Injuries: Animal Most Common, Machinery Most Lethal: An NTDB Study

2019 ◽  
Vol 85 (7) ◽  
pp. 752-756
Author(s):  
Karl Damroth ◽  
Rachel Damroth ◽  
Asad Chaudhary ◽  
Anfin Erickson ◽  
Liam Heneghan ◽  
...  
Keyword(s):  
Injury Severity ◽  
Data Bank ◽  
Trauma Patients ◽  
Age Group ◽  
Fatality Rate ◽  
P Values ◽  
Injury Type ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Farm Injuries

To characterize both emergency room (ER) and hospital discharge dispositions of patients presenting with farm-related injuries. The 2012 National Trauma Data Bank was queried in August 2017 for injuries occurring on a farm. Patients were stratified by gender, age group, race, Injury Severity Score (ISS), and injury type. We performed logistic regression analysis to correlate parameters with likelihood of discharge home or death. P values < 0.05 were considered significant. Five thousand six hundred thirty-one patients were identified, the majority of whom were male (72%) and white (85%). The most common mechanisms of injury included animal-related (29%), followed by falls, vehicles, and other causes. The highest ISSs were seen in vehicular injuries (11% ISS of 251) and the greatest fatality rate was seen in machinery injuries (4%). Four thousand seven hundred fifty-three (84%) patients were admitted to the hospital, and 4056 (72%) were discharged home from the ER or after hospitalization. One hundred thirty patients (2%) died of their farm-related injury. Most patients presenting to the ER with farm-related injuries survive, are admitted to the hospital, and are ultimately discharged home. Few patients die of their injuries. Animal injury is most common and machinery injury most lethal of farm trauma patients presenting to the ER.

Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank

2019 ◽  
Vol 85 (4) ◽  
pp. 342-349 ◽  
Author(s):  
Alexander A. Xu ◽  
Janis L. Breeze ◽  
Jessica K. Paulus ◽  
Nikolay Bugaev
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Data Bank ◽  
Esophageal Injury ◽  
Trauma Patients ◽  
Adult Age ◽  
National Trauma ◽  
National Trauma Data Bank

Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.

Permissive Hypotension: Potentially Harmful in the Elderly? A National Trauma Data Bank Analysis

2015 ◽  
Vol 81 (8) ◽  
pp. 770-777 ◽  
Author(s):  
Lindsay C. Bridges ◽  
Brett H. Waibel ◽  
Mark A. Newell
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Injury Severity ◽  
Damage Control ◽  
Data Bank ◽  
Trauma Patients ◽  
Permissive Hypotension ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Effect Of Age

Permissive hypotension is a component of damage control resuscitation that aims to provide a directed, controlled resuscitation, while countering the “lethal triad.” This principle has not been specifically studied in elderly (ELD) trauma patients (≥55 years). Given the ELD population's lack of physiologic reserve and risk of inadequate perfusion with “normal” blood pressures, we hypothesized that utilized a permissive hypotension strategy in ELD trauma patients would result in worse outcomes compared with younger patients (18–54 years). A retrospective review of National Trauma Data Bank reports from 2009 and 2010, identifying critically ill patients undergoing a “damage control laparotomy,” was performed to determine the effect of age and systolic blood pressure on outcome. Logistic regression analysis, including evaluation of an interaction between age and admission blood pressure, was performed on mortality using admission demographics, physiology, injury severity, mechanism of injury, and in-hospital complications. Although there was a higher likelihood of death with greater age, lower admission systolic blood pressure, lower Glasgow Coma Score, increased injury severity score, and acute renal failure, a synergistic effect of age and blood pressure on mortality was not identified. Permissive hypotension appears to be a possible management strategy in ELD trauma patients.

scholarly journals Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank

2020 ◽  
Vol 5 (1) ◽  
pp. e000441 ◽  
Author(s):  
Jesse Peek ◽  
Yassine Ochen ◽  
Noelle Saillant ◽  
Rolf H H Groenwold ◽  
Loek P H Leenen ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Flail Chest ◽  
Ventilatory Support ◽  
Data Bank ◽  
International Classification Of Diseases ◽  
Rib Fractures ◽  
Severe Injury ◽  
Level Of Evidence ◽  
National Trauma ◽  
National Trauma Data Bank

BackgroundIn recent years, there has been increasing interest in the treatment of patients with rib fractures. However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent. Furthermore, although it has been suggested that there is a large heterogeneity among patients with traumatic rib fractures, there is insufficient literature reporting on the outcomes of different subgroups.MethodsA retrospective cohort study using the National Trauma Data Bank was performed. All adult patients with one or more traumatic rib fractures or flail chest who were admitted to a hospital between January 2010 and December 2016 were identified by the International Classification of Diseases Ninth Revision diagnostic codes.ResultsOf the 564 798 included patients with one or more rib fractures, 44.9% (n=2 53 564) were patients with polytrauma. Two per cent had open rib fractures (n=11 433, 2.0%) and flail chest was found in 4% (n=23 388, 4.1%) of all cases. Motor vehicle accidents (n=237 995, 51.6%) were the most common cause of rib fractures in patients with polytrauma and flail chest. Blunt chest injury accounted for 95.5% (n=5 39 422) of rib fractures. Rib fractures in elderly patients were predominantly caused by high and low energy falls (n=67 675, 51.9%). Ultimately, 49.5% (n=2 79 615) of all patients were admitted to an intensive care unit, of whom a quarter (n=146 191, 25.9%) required invasive mechanical ventilatory support. The overall mortality rate was 5.6% (n=31 524).DiscussionTraumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. Worse outcomes were predominantly observed among patients with polytrauma and flail chest. Future studies should recognize these differences and treatment should be evaluated accordingly.Level of evidenceII/III.

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