scholarly journals Chest trauma in the older people: epidemiological profile and treatment outcome

2018 ◽  
Vol 5 (8) ◽  
pp. 2697
Author(s):  
Kelechi E. Okonta ◽  
Emmanuel O. Ocheli
Keyword(s):  
Older Persons ◽  
Chest Trauma ◽  
Injury Severity ◽  
Rib Fracture ◽  
Chest Injury ◽  
Thoracic Injury ◽  
Associated Injury ◽  
Severity Scores ◽  
Epidemiological Profile ◽  
Neurological Injuries

Background: There has not been any documented account of chest trauma among the older persons in Nigeria. The aim is to determine the epidemiological profile of chest injury in the old population.Methods: A prospective study of all the patients with chest trauma in two Nigeria tertiary hospitals for 4 years period. The bio-data, cause and type of chest injury, time between injury and presentation in the hospital, number of rib fractures, associated injury, injury severity score (ISS), treatment and outcome were analyzed using range and mean.Results: A total of 38(15.8%) older persons of 241 patients with chest trauma were analysed. Twenty-two (57.9%) patients were male with most of the patients being farmers and unskilled workers. Twenty-four (63.2%) patients sustained chest injury from motor vehicular crash while 10(26.3%) patients were from falls,2(5.3%) patients from gunshot injury and 2(5.3%) patients from other causes. The time between injury and presentation to the hospital ranged from 30-minutes to 5-days. Twenty-seven patients (71.1%) had rib fracture. The associated injuries were limb bone injuries in 10 (26.3%) patients, blunt abdominal injuries in 2(5.3%) patients and neurological injuries in 4 (10.6%) patients. The treatment in 35 (92.1%) patients was at least by chest tube insertion. The 30-day hospital mortality was 3(7.9%) from patients with injury severity scores of 32, 41 and 48 respectively.Conclusions: Traumatic chest injury in the older persons is still not common. Trauma to the limb bones was the commonest associated injury, and rib fracture was the commonest thoracic injury encountered. However, expeditious management led to reduced mortality recorded in this study.

Risk Factors Associated with Venous Thromboembolism in Isolated Blunt Chest Trauma

2013 ◽  
Vol 79 (5) ◽  
pp. 502-505 ◽  
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.

scholarly journals New horizons in rib fracture management in the older adult

2019 ◽  
Vol 49 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Roisin Coary ◽  
Conor Skerritt ◽  
Anthony Carey ◽  
Sarah Rudd ◽  
David Shipway
Keyword(s):  
Older Adults ◽  
Injury Severity ◽  
Scoring Systems ◽  
Pulmonary Complications ◽  
Research Literature ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Mortality And Morbidity ◽  
Severity Scores ◽  
Fracture Management

Abstract Adults aged ≥60 years now represent the majority of patients presenting with major trauma. Falls are the most common cause of injury, accounting for nearly three-quarters of all traumas in this population. Trauma to the thorax represents the second most common site of injury in this population, and is often associated with other serious injuries. Mortality rates are 2–5 times higher in older adults compared to their younger counterparts, often despite equivalent injury severity scores. Risk scoring systems have been developed to identify rib fracture patients at high risk of deterioration. Overall mortality from rib fractures is high, at approximately 10% for all ages. Mortality and morbidity from rib fractures primarily derive from pain-induced hypoventilation, pneumonia and respiratory failure. The main goal of care is therefore to provide sufficient analgesia to allow respiratory rehabilitation and prevent pulmonary complications. The provision of analgesia has evolved to incorporate novel regional anaesthesia techniques into conventional multimodal analgesia. Analgesia algorithms may aid early aggressive management and escalation of pain control. The current role for surgical fixation of rib fractures remains unclear for older adults who have been underrepresented in the research literature. Older adults with rib fractures often have multi-morbidity and frailty which complicate their injuries. Trauma services are evolving, and increasingly geriatricians will be embedded into trauma services to deliver comprehensive geriatric assessment. This review aims to provide an evidence-based overview of the management of rib fractures for the physician treating older patients who have sustained trauma.

Breast Hematoma: An Under-Recognized and Under-Reported Female-Specific Traumatic Injury and Its Clinical Significance

2020 ◽  
pp. 000313482094356
Author(s):  
Danielle LaSalle Hashmi ◽  
Adrian W. Ong ◽  
Alison Muller ◽  
MariaLisa Itzoe ◽  
Anthony Martin ◽  
...  
Keyword(s):  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Univariate Analysis ◽  
Traumatic Injury ◽  
Antithrombotic Agent ◽  
Female Patients ◽  
Severity Scores ◽  
Female Specific

Female-specific traumatic injury patterns have not been well researched and are potentially not well documented. Our aim was to examine the prevalence of breast hematomas (BHs) after blunt chest trauma, and to evaluate if there were risk factors associated with BH requiring intervention. A retrospective review from 2013 to 2018 was performed, identifying female patients ≥18 years sustaining blunt chest trauma. BH was defined as the presence of a collection of blood within the breast parenchyma, and clinically significant breast hematoma (CSBH) as BH requiring blood transfusion, surgical, or interventional radiology intervention. Univariate analysis was performed comparing CSBH with BH in terms of demographics, injury severity, antithrombotic agent use, and body mass index (BMI). Of 871 female patients meeting criteria, 59 (7%) had BH. Of these, 10 (17%) had CSBH (transfusion only, n = 3; angioembolization, n = 4; operation, n = 3). Compared to BH not requiring intervention, CSBH patients were older (mean age, 80 vs 69, P = .006), but had similar rates of motor vehicle crashes (90% vs 78%), seatbelt use (70% vs 71%), antiplatelet use (10% vs 12%), and anticoagulant use (10% vs 6%). Median Injury Severity Scores and median BMI (34 vs 34) were similar between the groups.

scholarly journals Blunt Chest Injury: epidemiological profile and determinant of mortality

2018 ◽  
Vol 5 (5) ◽  
pp. 1622
Author(s):  
Kelechi E. Okonta ◽  
Emmanuel O. Ocheli
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Formal Education ◽  
Injury Severity ◽  
Chest Injury ◽  
P Value ◽  
Chest Injuries ◽  
Tertiary Hospitals ◽  
Epidemiological Profile ◽  
A Prospective Study

Background: The identification of the epidemiological profile and the determinants of mortality for blunt chest injuries (BCI) ensures the proper documentation of susceptible patients, and the implementation of strategies for prompt and improved patients’ care.Methods: This is a prospective study for a 4-year period at two tertiary hospitals in Nigeria. The inclusion criteria were patients who had BCI, did chest radiograph and admitted for treatment. The statistical software for analysis was SPSS version 22 and using Pearson’s X2 and spearman’s X2 for correlation of mortality with the Injury Severity Score (ISS), Glasgow Coma Scale(GCS) and Hemi-thorax affected. The p-value was significant at <0.001.Results: I One-hundred and twenty-six (52.3%) of 241 patients had BCI, the average age was 40.4years with a range of 0.8-79years.There were 104 (82.5%) male with a ratio of 4.7:1. Most patients 86(68.3%) were between 19-59 years of age, 85 (67.5%)were unskilled workers and 57 (45%) had no formal education. Most 66.7% of the injuries occurred in the first half of the year with a peak (16.3%) in March. Mondays and Fridays,and, morning hours were the peak periods. BCI was by motor vehicular accidents 94 (74.6%), falls 28 (22.2%), and other causes 4 ((3.2%). The associated injuries were extremities 25(19.8%,), cranio-spinal injuries 17(13.5%) and blunt abdominal injuries13 (10.3%). Eleven (8.7%) patients died within one-month of admission. The determinants of mortality were high ISS (p<0.001), severe head injury (p<0.001) and bilateral chest injury (p<0.001).Conclusions: The contribution of falls to BCI is on the increase with BCI occurring at periods of increased activities like Mondays, Fridays and morning hours.The determinants of mortality were high  ISS ,severe head injury and bilateral chest injury.

scholarly journals Profile of chest trauma patients at B.P. Koirala Institute of Health Sciences, Dharan, Nepal

2017 ◽  
Vol 13 (3) ◽  
pp. 107-113
Author(s):  
Suresh Prasad Sah ◽  
R Agrawal ◽  
CS Agrawal ◽  
S Koirala
Keyword(s):  
Chest Trauma ◽  
Road Traffic ◽  
Flail Chest ◽  
Public Health Problem ◽  
Tracheobronchial Tree ◽  
Rib Fracture ◽  
Chest Injury ◽  
Physical Assault ◽  
Major Public Health Problem ◽  
Trauma Patients

Background: Chest trauma is a major public health problem. It includes injury to chest wall, pleura, tracheobronchial tree, lungs, diaphragm, esophagus, heart and great vessels. It comprises 10-15% of all traumas and 25% of death due to trauma occurs because of chest injury. Chest trauma is seen with increasing frequency in urban hospitals.Methods: A prospective study of all pati with chest injury irrespective of age, sex and mode of injury presenting to BPKIHS emergency were included in this study from 15th March 2007 to 14th March 2008.  Results: During the study period of one year total trauma patients presented toemergency were 1524. Out of this 122 patients were of chest injury. It comprises 8% of all trauma patients. Majority of patients belonged to the age group (21-40) years. Out of 122 patients, 57 (46.7%) patients sustained injury due to fall from height and was the commonest cause of trauma in this study followed by road traffic accident which was 38 (31.1%), 15 (12.3%) had physical assault and similar number of 6 patients (4.9%) sustained injury due to gunshot injury and stab injury. Out of 122 patients, 34 (27.9%) patients had associated injury. The most common chest injury was pneumothorax followed by isolated multiple rib fracture, hemothorax, isolated single rib fracture hemopneumothorax, flail chest, subcutaneous emphysema, lung contusion, open pneumothorax and tension pneumothorax.Conclusion: Majority of chest trauma patients were young adults with male preponderance. Blunt trauma chest was most common chest injury. Pneumothorax was the most common chest injury. Majority of patients were managed with tube thoracostomy, analgesics and chest physiotherapy. Health Renaissance 2015;13 (3): 107-113

scholarly journals First rib fractures as indicators of serious intra and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality

2019 ◽  
Vol 6 (4) ◽  
pp. 1056
Author(s):  
Majed Al-Mourgi
Keyword(s):  
Cervical Spine ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Morbidity And Mortality ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Thoracic Injuries ◽  
First Rib

Background: First-rib fractures are relatively rare compared with fractures of other ribs because of the broad structure deeply placed and protected location of the first rib. A high amount of energy is needed to cause a first-rib fracture; violent trauma, such as that involving motor vehicle accident, is a frequent cause of these fractures, as well as other serious intra-thoracic, head, cervical spine, and intra-abdominal injuries. First-rib fractures have traditionally been considered indicators of increased injury severity and mortality in major trauma patients. The aim was to study the significance of first-rib fractures as indicators of serious intra-thoracic and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality in a high-altitude area in Al-Taif, Saudi Arabia.Methods: This is a retrospective study conducted in King Abdul-Aziz Specialist Hospital (KASH), Taif City, KSA. Patients with chest injuries who presented to the emergency department and were admitted to the hospital between November 2013 and March 2016 were included in the study. Data regarding first-rib fracture were collected, and the relationship between first-rib injuries and associated intra-thoracic and extra-thoracic injuries was analyzed.Results: There was a high incidence of first-rib fracture (23.45%), and 35.8% were bilateral. The most common associated chest injury was a pulmonary contusion (58.5%), followed by pneumothorax (32.1%), hemopneumothorax (20.7%), and surgical emphysema (20.7%). The most common associated extra-thoracic injuries in our study were skeletal injuries (47.4%), cervical spine injuries (11.3%), and head trauma (24.5%).Conclusions: Fractures of the first-rib are associated with serious thoracic and extra-thoracic injuries; they are associated only with increased morbidity in patients with polytrauma and have no independent impact on mortality.

Chest Trauma Evaluation and Outcome of Management in a Tertiary Hospital - One Year Experience

2020 ◽  
Vol 22 (2) ◽  
pp. 110-117
Author(s):  
Md Mahmudul Islam ◽  
Khondkar AK Azad ◽  
Md Aminul Islam ◽  
Rivu Raj Chakraborty
Keyword(s):  
Road Traffic Accident ◽  
Traffic Accident ◽  
Chest Trauma ◽  
Road Traffic ◽  
Tube Thoracostomy ◽  
Rib Fracture ◽  
Medical College Hospital ◽  
College Hospital ◽  
Medical College ◽  
The Mean

Background: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after the trauma has occurred. Various therapeutic options have been reported for management of chest injuries like clinical observation, thoracocentesis, tube thoracostomy and open thoracotomy. Objective: To observe the pattern and outcome of management in chest trauma Methods: This is an observational study carried out in Casualty department of Chittagong Medical College Hospital (CMCH), Chittagong, between April 2015 to March 2016. Our study was included all patients, both sexes, following chest injury at Casualty units of Chittagong Medical College Hospital. All the data were recorded through the preformed data collection sheet and analyzed. Result: The mean age was found 37.7±18.1 years with range from 12 to 80 years. Male female ratio was 11.8:1. The mean time elapsed after trauma was found 6.1±3.1 hours with range from 1 to 72 hours. Almost one third (35.7%) patients was affecting road traffic accident followed by 42(27.3%) assault, 35(22.7%) stab injury, 15(9.7%) fall and 7(4.5%) gun shot . More than three fourth (80.5%) patients were managed by tube thoracostomy followed by 28(18.2%) observation and 2(1.3%) ventilatory support. No thoracotomy was done in emergency department. 42(27.2%) patients was found open pneumothorax followed by 41(26.6%) rib fracture, 31(20.1%) haemopneumothorax, 14(9%) simple pneumothorax, 12(7.8%) haemothorax, 6(3.9%) chest wall injury, 5(3.2%) tension pneumothorax, and 3(1.9%) flail chest. About the side of tube 60(39.0%) patients were given tube on left side followed by 57(37.0%) patients on right side, 9(5.8%) patients on both (left & right) side and 28(18.2%) patients needed no tube. Regarding the complications, 13(30%) patients had persistent haemothorax followed by 12(29%)tubes were placed outside triangle of safety, 6(13.9%) tubes were kinked, 6(13.9%) patients developed port side infection, 2(4.5%)tube was placed too shallow, 2(4.5%) patients developed empyema thoracis and 2(4.5%) patients developed bronchopleural fistula. The mean ICT removal information was found 8.8±3.6 days with range from 4 to 18 days. Reinsertion of ICT was done in 6(4.7%) patients. More than two third (68.2%) patients were recovered well, 43(27.9%) patients developed complication and 6(3.9%)patients died. More than two third (66.9%) patients had length of hospital stay 11-20 days. Conclusion: Most of the patients were in 3rd decade and male predominant. Road traffic accident and tube thoracostomy were more common. Open pneumothorax, rib fracture and haemopneumothorax were commonest injuries. Nearly one third of the patients had developed complications. Re-insertion of ICT needed almost five percent and death almost four percent. Journal of Surgical Sciences (2018) Vol. 22 (2) : 110-117

scholarly journals Nonoperative management of splenic injury in closely monitored patients with reduced consciousness is safe and feasible

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Michel Teuben ◽  
Roy Spijkerman ◽  
Taco Blokhuis ◽  
Roman Pfeifer ◽  
Henrik Teuber ◽  
...  
Keyword(s):  
Mental Status ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Splenic Trauma ◽  
Blunt Splenic Injury ◽  
Icu Stay ◽  
Severity Scores ◽  
Gcs Score ◽  
The Impact

Abstract Background Treatment of blunt splenic injury has changed over the past decades. Nonoperative management (NOM) is the treatment of choice. Adequate patient selection is a prerequisite for successful NOM. Impaired mental status is considered as a relative contra indication for NOM. However, the impact of altered consciousness in well-equipped trauma institutes is unclear. We hypothesized that impaired mental status does not affect outcome in patients with splenic trauma. Methods Our prospectively composed trauma database was used and adult patients with blunt splenic injury were included during a 14-year time period. Treatment guidelines remained unaltered over time. Patients were grouped based on the presence (Group GCS: < 14) or absence (Group GCS: 14–15) of impaired mental status. Outcome was compared. Results A total of 161 patients were included, of whom 82 were selected for NOM. 36% of patients had a GCS-score < 14 (N = 20). The median GCS-score in patients with reduced consciousness was 9 (range 6–12). Groups were comparable except for significantly higher injury severity scores in the impaired mental status group (19 vs. 17, p = 0.007). Length of stay (28 vs. 9 days, p < 0.001) and ICU-stay (8 vs. 0 days, p = 0.005) were longer in patients with decreased GCS-scores. Failure of NOM, total splenectomy rates, complications and mortality did not differ between both study groups. Conclusion This study shows that NOM for blunt splenic trauma is a viable treatment modality in well-equipped institutions, regardless of the patients mental status. However, the presence of neurologic impairment is associated with prolonged ICU-stay and hospitalization. We recommend, in institutions with adequate monitoring facilities, to attempt nonoperative management for blunt splenic injury, in all hemodynamically stable patients without hollow organ injuries, also in the case of reduced consciousness.

scholarly journals Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods

2021 ◽  
Vol 45 (5) ◽  
pp. 1340-1348
Author(s):  
Maryam Meshkinfamfard ◽  
Jon Kristian Narvestad ◽  
Johannes Wiik Larsen ◽  
Arezo Kanani ◽  
Jørgen Vennesland ◽  
...  
Keyword(s):  
Injury Severity ◽  
Trauma System ◽  
Severe Trauma ◽  
Emergency Procedure ◽  
Emergency Thoracotomy ◽  
Severity Scores ◽  
Time Periods ◽  
Low Volume ◽  
Time Critical ◽  
Over Time

Abstract Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.

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