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

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.

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Effect of Height of Fall on Mortality in Patients with Fall Accidents: A Retrospective Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17114163 ◽

2020 ◽

Vol 17 (11) ◽

pp. 4163

Author(s):

Ting-Min Hsieh ◽

Ching-Hua Tsai ◽

Hang-Tsung Liu ◽

Chun-Ying Huang ◽

Sheng-En Chou ◽

...

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Ground Level ◽

Cross Sectional ◽

Group Iii ◽

Group I ◽

Height Of Fall ◽

Group Ii ◽

Fall Accidents

Background: Accidental falls are a common cause of injury and deaths. Both ground-level falls (GLF) and non-GLF may lead to significant morbidity or mortality. This study aimed to explore the relationship between height of falls and mortality. Method: This is a retrospective study based on the data from a registered trauma database and included 8699 adult patients who were hospitalized between 1 January 2009 and 31 December 2017 for the treatment of fall-related injuries. Study subjects were divided into three groups of two categories based on the height of fall: GLF (group I: < 1 m) and non-GLF (group II: 1–6 m and group III: > 6 m). The primary outcome was in-hospital mortality. The adjusted odds ratio (AOR) of mortality adjusted for age, sex, and comorbidities with or without an injury severity score (ISS) was calculated using multiple logistic regression. Results: Among the 7001 patients in group I, 1588 in group II, and 110 in group III, patients in the GLF group were older, predominantly female, had less intentional injuries, and had more pre-existing comorbidities than those in the non-GLF group. The patients in the non-GLF group had a significantly lower Glasgow Coma Scale (GCS), a higher injury severity score (ISS), worse physiological responses, and required more procedures performed in the emergency department. The mortality rate for the patients in group I, II, and III were 2.5%, 3.5%, and 5.5%, respectively. After adjustment by age, sex, and comorbidities, group II and group III patients had significantly higher adjusted odds of mortality than group I patients (AOR 2.2, 95% CI 1.64–2.89, p < 0.001 and AOR 2.5, 95% CI 1.84–3.38, p < 0.001, respectively). With additional adjustment by ISS, group II did not have significantly higher adjusted odds of mortality than group I patients (AOR 1.4, 95% CI 0.95–2.22, p = 0.082), but group III patients still had significantly higher adjusted odds of mortality than group I patients (AOR 10.0, 95% CI 2.22–33.33, p = 0.002). Conclusion: This study suggested that patients who sustained GLF and non-GLF were distinct groups of patients, and the height of fall did have an impact on mortality in patients of fall accidents. A significantly higher adjusted odds of mortality was found in the GLF group than in the non-GLF group after adjusting for age, sex, and comorbidities.

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

The American Surgeon ◽

10.1177/000313481508100921 ◽

2015 ◽

Vol 81 (9) ◽

pp. 879-883 ◽

Cited By ~ 13

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.

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Intentional Injuries in Trauma Carry a Higher Risk of Mortality

10.21203/rs.2.9854/v1 ◽

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.

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Fatores prognósticos de mortalidade em pacientes com trauma cardíaco que chegam à sala de cirurgia

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/s0100-69912001000200003 ◽

2001 ◽

Vol 28 (2) ◽

pp. 87-94 ◽

Cited By ~ 4

Author(s):

Fernando Antonio Campelo Spencer Netto ◽

Josemberg Marins Campos ◽

Luís Filipe Cavalcanti Lima ◽

Marco Antonio C. P. Rivera ◽

Flávio Kreimer ◽

...

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Thoracic Trauma ◽

Injury Severity ◽

Penetrating Trauma ◽

Cardiac Trauma ◽

Penetrating Thoracic Trauma ◽

Penetrating Cardiac Trauma

OBJETIVO: Detectar índices de complicações pós-operatórias e de letalidade, identificando fatores de risco (mecanismo de trauma, sítio da lesão cardíaca, local da intervenção cirúrgica, lesões associadas, necessidade de transfusão e escores anatômicos de trauma) em pacientes com traumatismo cardíaco que apresentavam sinais vitais à admissão na sala de operações. MÉTODO: Realizou-se um estudo descritivo e analítico, de cunho retrospectivo, através dos prontuários de 52 pacientes, submetidos à toracotomia para tratamento de lesões cardíacas penetrantes entre julho/91 e março/97 em um centro de trauma no Nordeste do Brasil. RESULTADOS: O instrumento lesivo mais freqüente foi a arma branca em 28 pacientes (53,85%), seguidos pela arma de fogo em 24 (46,15%). A lesão de ventrículo direito isolada ocorreu em 25 casos (48,08%). As medianas dos escores anatômicos de trauma foram: injury severity score (ISS)=26; penetrating trauma index (PTI)=23; penetrating thoracic trauma index (PTTI)=20; e penetrating cardiac trauma index (PCTI)=15. A taxa de complicação pós-operatória foi de 36,54% e a de letalidade de 13,45%. O sangramento pós-operatório, a necessidade de reoperação e o uso de mais de três concentrados de hemácias aumentaram o risco relativo de morte. Os escores anatômicos de trauma não estiveram associados a aumento do risco relativo de letalidade. CONCLUSÕES: A maioria dos pacientes com lesão cardíaca desta série apresentou bons fatores prognósticos, justificando a baixa taxa de mortalidade observada.

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Tube Thoracostomy Management in the Combat Wounded

The American Surgeon ◽

10.1177/000313481808400852 ◽

2018 ◽

Vol 84 (8) ◽

pp. 1355-1362 ◽

Cited By ~ 1

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.

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

Journal of International Medical Research ◽

10.1177/03000605211061029 ◽

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.

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Long-Term Outcomes of Thoracic Trauma in U.S. Service Members Involved in Combat Operations

Military Medicine ◽

10.1093/milmed/usaa165 ◽

2020 ◽

Vol 185 (11-12) ◽

pp. e2131-e2136

Author(s):

Stephen M Hughes ◽

Charles W Borders ◽

James K Aden ◽

Tyson J Sjulin ◽

Michael J Morris

Keyword(s):

Pulmonary Function ◽

Injury Severity Score ◽

Severity Score ◽

Thoracic Trauma ◽

Injury Severity ◽

Service Members ◽

Thoracic Injuries ◽

Long Term Outcomes ◽

Type Of Injury

ABSTRACT Introduction Nearly 10% of all combat injuries during the most recent conflicts in Iraq and Afghanistan involve thoracic trauma. The long-term outcomes of these combat-related injuries with respect to lung function have not been fully evaluated. Limited research in civilian polytrauma patients have shown significant obstructive physiology in nearly half of their population without clear etiology. We sought to further characterize the extent to which these active duty service members (ADSM) are chronically affected by their thoracic injuries. Materials and Methods We conducted a retrospective chart review and analysis of ADSM who sustained thoracic injuries while deployed in support combat operations from 2003 to 2013. Using the Department of Defense Trauma Registry, 2,049 patients were found to have sustained thoracic trauma during these conflicts, of which we were able to identify 298 patients with postinjury pulmonary function testing (PFT) available for analysis. Following standardization of these tests using the established reference values, PFT was compared to a representative population of ADSM. Additional analysis was completed to detect incidence of abnormal PFTs when compared to both type of injury (burn, blunt, penetrating, and other) and also Injury Severity Score. Results In our patient population, there was a significant increase in abnormal PFTs when compared to a representative population. Of these, 31.8% of patients displayed obstructive physiology versus 3.7% in the control (P < 0.001), 24.5% displayed restrictive or restrictive pattern (those without full lung volumes available utilizing forced vital capacity) versus 4.9% (P < 0.0001), and 7.9% displaying mixed pattern. Further, increasing rates of abnormal PFTs were identified in comparison to Injury Severity Score (odds ratio 1.03). There was no significant increase in abnormal PFTs when stratified by type of injury. Finally, there was no significant change identified in pulmonary function before and after injury in our limited population of 19 patients. Conclusions There is a significant increase in the percent of abnormal PFTs in ADSM following thoracic injury when compared to patients with similar risk factors and baseline health. It is unclear why the rates of obstruction are high in our population as previous research has not definitively shown increased rates of asthma in previously deployed, uninjured ADSM; however, this finding is consistent with limited previous research in civilian trauma patients. Further research into the long-term outcomes of thoracic trauma and occupational exposures of combat is paramount for improved outcomes going forward.

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Disseminierte intravasale Gerinnung und Fibrinolyse in der Frühphase nach Polytrauma

Hämostaseologie ◽

10.1055/s-0038-1655291 ◽

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.

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

The American Surgeon ◽

10.1177/00031348211024973 ◽

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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Efficacy of nebulised L-adrenaline with 3% hypertonic saline versus normal saline in bronchiolitis

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v7i1.29141 ◽

2016 ◽

Vol 7 (1) ◽

pp. 15

Author(s):

Shabnam Sharmin ◽

Laila Helaly ◽

Zakir Hossain Sarker ◽

Ruhul Amin ◽

Shafi Ahmed ◽

...

Keyword(s):

Oxygen Saturation ◽

Respiratory Rate ◽

Hypertonic Saline ◽

Normal Saline ◽

Severity Score ◽

Saline Group ◽

Clinical Severity ◽

Clinical Severity Score ◽

Group I ◽

Group Ii

Background: Bronchiolitis is one of the most common respiratory diseases requiring hospitalization. Nebulized epinephrine and salbutamol therapy has been used in different centres with varying results. Objective: The objective of the study was to compare the efficacy of nebulised adrenaline diluted with 3% hypertonic saline with nebulised adrenaline diluted with normal saline in bronchiolitis. Methods: Fifty three infants and young children with bronchiolitis, age ranging from 2 months to 2 years, presenting in the emergency department of Manikganj Sadar Hospital were enrolled in the study. After initial evaluation, patients were randomized to receive either nebulized adrenaline I .5 ml ( 1.5 mg) diluted with 2 ml of3% hypertonic saline (group I) ornebulised adrenaline 1.5 ml (1.5 mg) diluted with 2 ml of normal saline (group II). Patients were evaluated again 30 minutes after nebulization. Results: Twenty eight patients in the group I (hypertonic saline) and twenty five in groupII (normal saline) were included in the study. After nebulization, mean respiratory rate decreased from 63.7 to 48.1 (p<.01), mean clinical severity score decreased from 8.5 to 3.5 (p<.01) and mean oxygen satw·ation increased 94.7% to 96.9% (p<.01) in group I. In group II, mean respiratory rate decreased from 62.4 to 47.4 (p<.01), mean clinical severity score decreased from 7.2 to 4.1 (p<.01) and mean oxygen saturation increased from 94. 7% to 96. 7% (p<.01). Mean respiratory rate decreased by 16 in group I versus 14.8 (p>.05) in group 11, mean clinical severity score decreased by 4.6 in group versus 3 (p<.05) in group, and mean oxygen saturation increased by 2.2% and 1.9% in group and group respectively. Difference in reduction in clinical severity score was statistically significant , though the changes in respiratory rate and oxygen saturation were not statistically significant. Conclusion: The study concluded that both nebulised adrenaline diluted with 3% hypertonic saline and nebulised adrenaline with normal saline are effective in improving respiratory rate, clinical severity score and oxygen saturation in infants with bronchiolitis; and nebulised adrenaline with hypertonic saline is more effective than nebulised adrenaline with normal saline in improving clinical severity score in bronchiolitis.

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