Tube Thoracostomy Management in the Combat Wounded

2018 ◽  
Vol 84 (8) ◽  
pp. 1355-1362 ◽  
Author(s):  
Joseph D. Bozzay ◽  
Patrick F. Walker ◽  
Alley E. Ronaldi ◽  
Eric A. Elster ◽  
Carlos J. Rodriguez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Multivariable Analysis ◽  
Tube Thoracostomy ◽  
Traumatic Injuries ◽  
Retained Hemothorax ◽  
Improvised Explosive ◽  
Explosive Devices

The intent of this study was to characterize the management and subsequent complications of combat injury tube thoracostomies and to determine risk factors for the development of pneumonia (PNA) and retained hemothorax (RH). One hundred fifteen patients with 173 tube thoracostomies met the inclusion criteria and were analyzed. The mean injury severity score was 30.8 1 11.6, 23.5 per cent had traumatic amputations, 49.7 per cent had a hemothorax, and 50.3 per cent had a pneumothorax as indications for tube thoracostomy (TT) placement. Within 24 hours of injury, 89.6 per cent were intubated, the majority (54%) were injured by improvised explosive devices, 35.6 per cent sustained rib fractures, and 12.2 per cent had a diaphragm injury. A mean of 1.5 1 0.7(range 1–4) tube thoracostomies were placed, 18.3 per cent of patients had bilateral tube thoracostomies, and the average TT duration was 6.7 1 3.9 days. The incidence of PNA was 27 per cent (n = 31), RH was 9.6 per cent (n = 11), and empyema was 1.7 per cent (n = 2). Multivariable analysis identified the duration of ventilation [OR 1.2, 95% confidence interval (CI): 1.097–1.313, P < 0.001] as independently associated with the development of PNA. Bilateral TT placement (OR 3.848, 95% CI: 1.219–12.143, P = 0.0216) and injury severity score (OR 1.050, 95% CI: 1.001–1.102, P = 0.0443) were independently associated with PNA development when a patient was intubated for eight days or less. The number of tube thoracostomies placed (OR 3.08, 95% CI: 1.03–9.18, P = 0.0439) was independently associated with the development of RH. Further research is warranted to identify modifiable risk factors to reduce the incidence of PNA and RH in patients with TT placed for traumatic injuries.

Assessing Incidence and Risk Factors of Cervical Spine Injury in Blunt Trauma Patients Using the National Trauma Data Bank

2015 ◽  
Vol 81 (9) ◽  
pp. 879-883 ◽  
Author(s):  
Andrew J. Young ◽  
Luke Wolfe ◽  
Glenn Tinkoff ◽  
Therese M. Duane
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Alcohol Intoxication ◽  
Spine Injury ◽  
Ligamentous Injury ◽  
National Trauma

Despite the potentially devastating impact of missed cervical spine injuries (CI), there continues to be a large disparity in how institutions attempt to make the diagnosis. To better streamline the approach among institutions, understanding incidence and risk factors across the country is paramount. We evaluated the incidence and risk factors of CI using the National Trauma Databank for 2008 and 2009. We performed a retrospective review of the National Trauma Databank for 2008 and 2009 comparing patients with and without CI. We then performed subset analysis separating injury by patients with and without fracture and ligamentous injury. There were a total of 591,138 patients included with a 6.2 per cent incidence of CI. Regression found that age, Injury Severity Score, alcohol intoxication, and specific mechanisms of motor vehicle crash (MVC), motorcycle crash (MCC), fall, pedestrian stuck, and bicycle were independent risk factors for overall injury ( P < 0.0001). Patients with CI had longer intensive care unit (8.5 12.5 vs 5.1 7.7) and hospital lengths of stay (days) (9.6 14.2 vs 5.3 8.1) and higher mortality (1.2 per cent vs 0.3%), compared with those without injury ( P < 0.0001). There were 33,276 patient with only fractures for an incidence of 5.6 per cent and 1875 patients with ligamentous injury. Just over 6 per cent of patients suffer some form of CI after blunt trauma with the majority being fractures. Higher Injury Severity Score and MVC were consistent risk factors in both groups. This information will assist in devising an algorithm for clearance that can be used nationally allowing for more consistency among trauma providers.

scholarly journals Management of thoracic trauma and analysis of risk factors in thoracic trauma patients

2020 ◽  
Author(s):  
Morris Beshay ◽  
Fritz Mertzlufft ◽  
Hans Werner Kottkamp ◽  
Thomas Vordemvenne ◽  
Marc Reymond ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Severity Score ◽  
Severity Score ◽  
Thoracic Trauma ◽  
Chest Trauma ◽  
Injury Severity ◽  
Complication Rates ◽  
Group I ◽  
Group Ii ◽  
Severe Lung

Abstract Objectives:Thoracic trauma (TT) is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. Its management is still a very challenging task. The purpose of this study was to analyse the epidemiological finding, risk factors affecting the outcome in a high volume trauma centre.Patients and methods:Between January 2003 and December 2012 data of all patients admitted to the Accident and Emergency (A&E) were prospectively collected at the German Trauma Registry (GTR) thereafter retrospectively analysed.Patients with chest trauma and Injury Severity Score (ISS) ≥18 and Abbreviated Injury Scale (AIS) >2 in more than one body region were included. Patients were divided into two groups; group I included patients with thoracic trauma between January 2003 to December 2007. The results of this group were compared with the results of other group (group II) in a later five years period (Jan. 2008-Dec. 2012). Univariate and multivariate analysis was done, Statistical difference with P<0.05 were considered significant.Results:There were 630 patients (56%) with thoracic trauma. 540 patients (48%) had associated extra thoracic injuries. Group I consisted of 285 patients (197 male, mean age 46 years). Group II consisted of 345 patients (251 male, mean age 49 year). Overall 90 days mortality was 17% (n=48) in group I vs. 9% (n=31) in group II (p=0.024). Complication rates were higher in group I (p=0.019). Higher injury severity score (ISS), and higher abbreviated injury score (AIS) thoracic showed higher rate of mortality (p<0.0001). Young patients (< 40 years) were frequently exposed to severe thoracic injury but showed less mortality rates (p=0.014). Patients with severe lung contusions (n=94) (15%) had higher morbidity and mortality (p<0.001). 23 (8%) Patients had emergency thoracotomy in group I vs. 14 patients (4%) in group II (p=0.041). Organ replacement procedures were needed in 18% in group I vs. 31% in group II (p=0.038).Conclusions:The presence of severe lung contusion, higher ISS and AISthoracic and advanced age are directly related to higher mortality rate. Instantly management of blunt chest trauma with corrected chest tube insertion, optimal pain control and chest physiotherapy resulted in good outcome in the majority of patients. Optimal management with better survival rates is achievable in specialized centre with a multidisciplinary teamwork and the presence of thoracic surgical experience.

scholarly journals Residual Hemothorax after Chest Tube Placement Correlates with Increased Risk of Empyema Following Traumatic Injury

2008 ◽  
Vol 15 (5) ◽  
pp. 255-258 ◽  
Author(s):  
Riyad Karmy-Jones ◽  
Michele Holevar ◽  
Ryan J Sullivan ◽  
Ani Fleisig ◽  
Gregory J Jurkovich
Keyword(s):  
Lactate Dehydrogenase ◽  
Injury Severity Score ◽  
Chest Tube ◽  
Severity Score ◽  
Injury Severity ◽  
Tube Thoracostomy ◽  
Tube Placement ◽  
Serum Lactate Dehydrogenase ◽  
Chest Tube Placement ◽  
Increased Risk

BACKGROUND: Empyema complicates tube thoracostomy following trauma in up to 10% of cases. Studies of potential risk factors of empyema have included use of antibiotics, site of injury and technique of chest tube placement. Residual fluid has also been cited as a risk factor for empyema, although the imaging technique to identify this varies.OBJECTIVE: To determine whether residual hemothorax detected by chest x-ray (CXR) after one or more initial chest tubes predicts an increased risk of empyema.METHODS: A study of patients admitted to two level I trauma centres between January 7, 2004, and December 31, 2004, was conducted. All patients who received a chest tube in the emergency department, did not undergo thoracotomy within 24 h, and survived more than two days were followed. Empyema was defined as a pleural effusion with positive cultures, and a ratio of pleural fluid lactate dehydrogenase to serum lactate dehydrogenase greater than 0.6 in the setting of elevated leukocyte count and fever. Factors analyzed included the presence of retained hemothorax on CXR after the most recent tube placement in the emergency room, age, mechanism of injury and injury severity score.RESULTS: A total of 102 patients met the criteria. Nine patients (9%) developed empyema: seven of 21 patients (33%) with residual hemothorax developed empyema versus two of 81 patients (2%) without residual hemothorax developed empyema (P=0.001). Injury severity score was significantly higher in those who developed empyema (31.4±26) versus those who did not (22.6±13; P=0.03).CONCLUSIONS: The presence of residual hemothorax detected by CXR after tube thoracostomy should prompt further efforts, including thoracoscopy, to drain it. With increasing injury severity, there may be increased benefit in terms of reducing empyema with this approach.

Intentional Injuries in Trauma Carry a Higher Risk of Mortality

2019 ◽  
Author(s):  
Saif Sait ◽  
Yahya Ibrahim ◽  
Peyman Bakhshayesh
Keyword(s):  
Risk Factors ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Multivariate Regression Analysis ◽  
Factors Affecting ◽  
Intentional Injuries ◽  
Revised Trauma Score ◽  
Potential Risk Factors ◽  
Intentional Group

Abstract Background: There are several predictive models to identify risk factors for mortality in the context of trauma, such as Trauma Injury Severity Score (TRISS), Revised Trauma Score (RTS), and Injury Severity Score (ISS). Most of these models identify physiological parameters such as low GCS, presence of shock and on-going hemorrhage, or organ related injuries as potential risk factors for mortality. Intentional reason of injury is however, not being highlighted as a risk factor for mortality. We aimed to assess whether intentional injury was a contributing factor to mortality. Methods: Data from SweTrau (Swedish National Trauma Registry). Intentional injuries compared to non-intentional injuries. Multivariate regression analysis was conducted. Stepwise forward and backward regression was conducted. Results: A total number of 3875 patients were included. There were 3613 (93%) non-intentional and 262 (7%) intentional patients. The 30-day mortality rate was higher in the intentional group compared to non-intentional group, 10% vs. 4% (p<0.001). Patients in the intentional group were younger than the non-intentional group, at 39±18 vs. 47±21 years old (p<0.001). In both, the forward and backward tests injury intention remained statistically significant with OR 2 (CI 1.1-3.7). Shock (OR 4.7, CI 2.9-7.8), Severe Head Injury (OR 8.9, CI 5.3-14.7), Age ≥ 60 (OR 6.7, CI 4.1-10.8), ISS ≥16 (OR 10.8, CI 6.9-16.9) and ASA (OR 3.5, CI 2.2-5.7) were other factors affecting mortality. Conclusion: Injury intention was an independent factor contributing to mortality in our study. This particular cohort need further attention during trauma management with a holistic insight to improve their survival.

scholarly journals Risk factors for ventilator-associated pneumonia in trauma patients with torso injury: a retrospective single-center study

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110610
Author(s):  
Jin Young Lee ◽  
Young Hoon Sul ◽  
Se Heon Kim ◽  
Jin Bong Ye ◽  
Jin Suk Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Severity Score ◽  
Nasogastric Tube ◽  
Severity Score ◽  
Injury Severity ◽  
Multivariable Logistic Regression Analysis ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Highly Correlated ◽  
Stage Renal Disease

Objective We aimed to identify the risk factors for ventilator-associated pneumonia in patients admitted to critical care after a torso injury. Methods We retrospectively evaluated 178 patients with torso injury aged >15 years who were intubated in the emergency room and placed on a mechanical ventilator after intensive care unit (ICU) admission, survived for >48 hours, had thoracic and/or abdominal injuries, and had no end-stage renal disease. We compared clinico-laboratory variables between ventilator-associated pneumonia (n = 54, 30.3%) and non-ventilator-associated pneumonia (n = 124, 69.7%) groups. Risk factors for ventilator-associated pneumonia were assessed using multivariable logistic regression analysis. Results Ventilator-associated pneumonia was associated with a significantly longer stay in the ICU (11.3 vs. 6.8 days) and longer duration of mechanical ventilation (7 vs. 3 days). Injury Severity Score (adjusted odds ratio [AOR]: 1.048; 95% confidence interval [CI]: 1.008–1.090), use of vasopressors (AOR: 2.541; 95% CI: 1.121–5.758), and insertion of a nasogastric tube (AOR: 6.749; 95% CI: 2.397–18.999) were identified as independent risk factors of ventilator-associated pneumonia. Conclusion Ventilator-associated pneumonia in patients with torso injury who were admitted to the ICU was highly correlated with Injury Severity Score, use of vasopressors, and insertion of a nasogastric tube.

Disseminierte intravasale Gerinnung und Fibrinolyse in der Frühphase nach Polytrauma

1995 ◽  
Vol 15 (02) ◽  
pp. 79-86
Author(s):  
L. Lampl ◽  
M. Helm ◽  
M. Tisch ◽  
K. H. Bock ◽  
E. Seifried
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Tissue Type ◽  
Disseminierte Intravasale Gerinnung

ZusammenfassungGerinnungsstörungen nach einem Polytrauma werden eine große Bedeutung für die weitere Prognose der Patienten beigemessen. In einer prospektiv angelegten Studie wurden bei 20 polytraumatisierten Patienten Gerinnungsund Fibrinolyseparameter analysiert, um deren Veränderungen während der präklinischen Phase zu definieren. Die Blutentnahmen wurden zum frühestmöglichen Zeitpunkt am Unfallort und bei Klinikübergabe durchgeführt. Die gewonnenen Proben wurden mit Hilfe eines speziell konzipierten »Kleinlabors« noch vor Ort verarbeitet, um möglichst native Meßwerte zu erhalten. Die Patienten wurden dem Schweregrad der Verletzung entsprechend kategorisiert und hatten einen Verletzungsschweregrad nach NACA > IV und einen Injury Severity Score (ISS) > 20. Die Ergebnisse zeigen, daß bereits in der sehr frühen Phase nach Eintritt des Traumas schwerwiegende Veränderungen des Gerinnungsund Fibrinolysesystems eintreten. Die frühzeitige Thrombingenerierung führt zu einer Verbrauchskoagulopathie und reaktiven Hyperfibrinolyse. Zusätzlich erzeugt die Freisetzung von endothelständigem Tissue-type-Plasminogenaktivator eine primäre Hyperfibrinolyse. Die Veränderungen des Gerinnungsund Fibrinolysesystems in der frühen präklinischen Phase nach Polytrauma können zu schwerwiegenden klinischen Komplikationen wie Blutungen, thromboembolischen Komplikationen und zur Ausbildung von Schockorganen führen.

Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation

2021 ◽  
pp. 000313482110249
Author(s):  
Leonardo Alaniz ◽  
Omaer Muttalib ◽  
Juan Hoyos ◽  
Cesar Figueroa ◽  
Cristobal Barrios
Keyword(s):  
Computed Tomography ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Treatment Plan ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Severity Scores ◽  
Score Inflation

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

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