Delayed Respiratory Failure After Blunt Chest Trauma

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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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 surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure

Surgical Endoscopy ◽

10.1007/s00464-015-4207-9 ◽

2015 ◽

Vol 30 (1) ◽

pp. 388-395 ◽

Cited By ~ 17

Author(s):

Yih-Wen Tarng ◽

Yuan-Yuarn Liu ◽

Fong-Dee Huang ◽

Hsing-Lin Lin ◽

Tzu-Chin Wu ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Rib Fractures ◽

Titanium Elastic Nail ◽

Multiple Rib Fractures ◽

Elastic Nail

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Analysis of Scoring System to Identify High Risk Patients and their Outcome in Isolated Blunt Chest Trauma- A Prospective Observational Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46682.14749 ◽

2021 ◽

Author(s):

Annrish Tan Baby ◽

Anuraj Appukuttan ◽

Harihara Jothi ◽

Reema Sajan

Keyword(s):

Observational Study ◽

Scoring System ◽

Blunt Chest Trauma ◽

Prospective Observational Study ◽

Chest Trauma ◽

Tertiary Care ◽

Treatment Protocol ◽

Rib Fractures ◽

Morbidity And Mortality ◽

P Value

Introduction: Chest trauma is a major cause of mortality accounting for a substantial proportion of all trauma admissions and death. In India, the reported mortality range is between 4-60% and no current national guidelines exist to assist the management of this patient group unless patient has severe immediate life threatening injuries. A scoring system for identification of patients at higher risk for development of morbidity and mortality will allow early selection of vulnerable patients, choice of an appropriate treatment protocol and therapeutic interventions. Aim: This present study aims for the analysis of a scoring system to identify patients with isolated blunt chest trauma at higher risk for morbidity and mortality, in order to prioritise intervention and improve the outcome. Materials and Methods: This was a prospective observational study conducted at the departments of emergency medicine and general surgery of a tertiary care teaching hospital in South India over a period of 18 months. The study included 85 isolated blunt chest trauma patients. We utilised a Chest Trauma Score (CTS) composed of patient factors like age, smoking, lung disease and severity factors like rib fractures, parenchymal and pleural involvement, partial pressure of oxygen/ fraction of inspired oxygen (PaO2/FiO2) ratio. CTS were applied at the time of admission after detailed assessment of all injuries. Patient was followed-up at regular intervals upto 30 days. The CTS and outcome measurements were analysed using logistic regression analysis. Results: The area under Receiver Operating Characteristic curve (ROC) was found to be 0.979 (p-value <0.001). The CTS cut-off value was ≥11.5 with 89% sensitivity and 95% specificity. In patients with CTS ≥11.5, 98.3% had associated morbidity and complications whereas only 25.9% with CTS <11.5 had associated morbidity (p-value<0.001). Number of rib fractures, pulmonary contusion and PaO2/FiO2 ratio (odds ratio 10.632, 6.007, 12.859, respectively) were found to be significant independent predictors of morbidity and complications. Conclusion: In summary, CTS ≥11.5 has shown a significant association with poor outcome. Patients who sustained isolated blunt chest trauma and together with increasing scores, had increasing incidence of morbidity and complications. The scoring system used in this study proved that it makes a useful tool to predict the outcome in thoracic trauma.

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Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review

CJEM ◽

10.1017/cem.2017.377 ◽

2018 ◽

Vol 20 (4) ◽

pp. 614-622 ◽

Cited By ~ 5

Author(s):

Jake Sawa ◽

Robert S. Green ◽

Brent Thoma ◽

Mete Erdogan ◽

Philip J. Davis

Keyword(s):

Risk Factors ◽

Older Adults ◽

Prognostic Factors ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Injury Severity ◽

Adverse Outcomes ◽

Rib Fractures ◽

Factors Associated ◽

Chest Wall Trauma

ABSTRACTObjectivesThe objective of this study was to systematically review the published literature for risk factors associated with adverse outcomes in older adults sustaining blunt chest trauma.MethodsEMBASE and MEDLINE were searched from inception until March 2017 for prognostic factors associated with adverse outcomes in older adults sustaining blunt chest trauma using a pre-specified search strategy. References were independently screened for inclusion by two reviewers. Study quality was assessed using the Quality in Prognostic Studies tool. Where appropriate, descriptive statistics were used to evaluate study characteristics and predictors of adverse outcomes.ResultsThirteen cohort studies representing 79,313 patients satisfied our selection criteria. Overall, 26 prognostic factors were examined across studies and were reported for morbidity (8 studies), length of stay (7 studies), mortality (6 studies), and loss of independence (1 study). No studies examined patient quality of life or emergency department recidivism. Prognostic factors associated with morbidity and mortality included age, number of rib fractures, and injury severity score. Although age and rib fractures were found to be associated with adverse outcomes in more than 3 studies, meta-analysis was not performed due to heterogeneity amongst included studies in how these variables were measured.ConclusionsWhile blunt chest wall trauma in older adults is relatively common, the literature on prognostic factors for adverse outcomes in this patient population remains inadequate due to a paucity of high quality studies and lack of consistent reporting standards.

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Early Non-invasive Ventilation and High-flow Nasal Oxygen Therapy for Preventing Delayed Respiratory Failure in Hypoxemic Blunt Chest Trauma Patients.

Case Medical Research ◽

10.31525/ct1-nct03943914 ◽

2019 ◽

Author(s):

Keyword(s):

Respiratory Failure ◽

Blunt Chest Trauma ◽

Oxygen Therapy ◽

Chest Trauma ◽

High Flow ◽

Trauma Patients ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

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Comparison of Chest Computed Tomography and Chest X-Ray in the Diagnosis of Rib Fractures in Patients with Blunt Chest Trauma

Journal of Academic Emergency Medicine ◽

10.5152/jaem.2012.025 ◽

2012 ◽

Cited By ~ 1

Author(s):

Rasih Yazkan ◽

Gokhan Ergene ◽

Cumhur Murat Tulay ◽

Sedat Gunes ◽

Serdar Han

Keyword(s):

Computed Tomography ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Rib Fractures ◽

Chest Computed Tomography ◽

X Ray ◽

Chest X Ray

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Effect of ondansetron on spinal induced hypotension in caesarean deliveries

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v8i4.32384 ◽

2020 ◽

Vol 8 (4) ◽

pp. 193-199

Author(s):

Pujan Balla ◽

Anil Shrestha ◽

Ninadini Shrestha ◽

Navindra Bista ◽

Moda Nath Marhatta

Keyword(s):

Spinal Anesthesia ◽

Elective Caesarean Section ◽

P Value ◽

Chi Square ◽

Induced Hypotension ◽

Intergroup Comparison ◽

Chi Square Test ◽

The Mean ◽

Student’S T ◽

Student’S T Test

Background: Spinal anesthesia is the preferred technique of anesthesia employed for caesarean sections. However, it is very often complicated by hypotension. Different drugs and techniques have been used to prevent the hypotension induced by spinal anesthesia. In this study, the effect of ondansetron on the prevention of hypotension after spinal anesthesia was evaluated. Objectives: To determine the effect of prophylactic ondansetron on prevention of spinal induced hypotension in elective caesarean section. Methodology: Eighty-six parturients planned for elective caesarean deliveries were randomized into two groups of 43 each. Group O received Ondansetron 4 mg (4 ml) and Group S received Normal Saline (4 ml) intravenously 10 minutes prior to spinal anesthesia. Blood pressure, heart rate, phenylephrine requirements, occurrence of nausea and vomiting and APGAR scores of neonates were compared between the groups. Hemodynamic data was analyzed using Student’s t-test for intergroup comparison and ANOVA was used for intragroup comparison. Categorical data was analyzed using Pearson Chi-Square test. For all determinants, p-value <0.05 was considered significant. Results: Occurrence of hypotension in Group O (20.9 %) was significantly lower than in Group S (72.1%) (p < 0.05). The mean arterial pressure was significantly higher in Group O at 2, 6, 8, 12 and 14 minutes (p < 0.05). The use of phenylephrine (37.21 mcg vs. 146.51 mcg, p < 0.05) and occurrence of nausea (11.6%, vs. 41.9% p < 0.002) was significantly lower in ondansetron group. Conclusion: Ondansetron is effective in preventing spinal induced hypotension in elective caesarean sections.

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Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases

PLoS ONE ◽

10.1371/journal.pone.0224105 ◽

2019 ◽

Vol 14 (12) ◽

pp. e0224105 ◽

Cited By ~ 1

Author(s):

Christian Liebsch ◽

Tina Seiffert ◽

Markus Vlcek ◽

Meinrad Beer ◽

Markus Huber-Lang ◽

...

Keyword(s):

Blunt Chest Trauma ◽

Chest Trauma ◽

Rib Fractures

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Prevalence of Delayed Hemothorax in Blunt Thoracic Trauma

The American Surgeon ◽

10.1177/000313480507100606 ◽

2005 ◽

Vol 71 (6) ◽

pp. 481-486 ◽

Cited By ~ 16

Author(s):

Om P. Sharma ◽

Sara Hagler ◽

Michael F. Oswanski

Keyword(s):

Critical Care ◽

Mortality Rate ◽

Thoracic Trauma ◽

Injury Severity ◽

Age Groups ◽

Rib Fractures ◽

P Value ◽

Blunt Thoracic Trauma ◽

Younger Patients ◽

Current Report

Delayed hemothorax (DHTX) is rarely seen. On an 8-year retrospective analysis of blunt thoracic trauma (BTT), hemothorax (HTX) was diagnosed in 167 patients: 18 children, 113 adults, and 36 elderly. No statistical differences were seen in any age groups regarding Injury Severity Score (mean ISS, 30.54), critical care length of stay (CLOS, 9.0), and hospital LOS (HLOS, 11.21). Mortality rate was 18 per cent in adults and 28 per cent in elderly ( P value < 0.0001). HTX was acute in 160 and delayed in 7 patients. Two-thirds of HTX patients were males and 75 per cent had rib fractures. All of our DHTX patients were males (5 adults and 2 elderly) and had rib fractures. Acute HTX was seen in younger patients (43.3 vs 56.1 years, P value 0.46), with higher ISS (31.44 vs 14.43, P value < 0.001), CLOS (7.19 vs 3.0 days, P value 0.511) and HLOS (11.9 vs 11.6, P value 0.468). Mortality was 22.5 per cent in AHTX and none in DHTX. Eighty-six per cent of DHTX and 49 per cent of AHTX patients went home on discharge. DHTX was rare (5%) in the current report with lower ISS, HLOS, and no mortality. Patients with rib fractures should be watched for development of DHTX as timely diagnosis and treatment is essential for favorable outcome.

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