Injuries to the Chest Part 1

2019 ◽  
Author(s):  
Erika B. Call ◽  
Amy N. Hildreth ◽  
J. Jason Hoth
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Resuscitative Thoracotomy ◽  
Pulmonary Laceration ◽  
Tracheobronchial Injury ◽  
Early Trauma

Thoracic injury is common and is associated with significant morbidity and mortality. Injuries to the chest are responsible for 25% of blunt trauma fatalities and contribute to an additional 50% of deaths in this population.1 Fortunately, the majority of thoracic injuries can be treated effectively, and often definitively, by relatively simple maneuvers that can be learned and performed by most physicians involved in early trauma care. Only 5 to 10% will require operative intervention.2 These extremes in injury severity are unique to the chest and require treatment by a surgeon with a correspondingly broad range of knowledge and skills.  This article will address the following procedures and injuries:  tube thoracostomy, thoracotomy, emergency department resuscitative thoracotomy, video-assisted thoracoscopy, chest wall injuries including rib fractures and flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion and laceration, and tracheobronchial injury. This review 6 figures, 1 table, and 49 references. Keywords: Tube thoracoscopy, emergency department resuscitative thoracotomy (EDRT), rib fractures, flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion, pulmonary laceration, tracheobronchial injury

Injuries to the Chest Part 1

2019 ◽  
Author(s):  
Erika B. Call ◽  
Amy N. Hildreth ◽  
J. Jason Hoth
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Resuscitative Thoracotomy ◽  
Pulmonary Laceration ◽  
Tracheobronchial Injury ◽  
Early Trauma

Thoracic injury is common and is associated with significant morbidity and mortality. Injuries to the chest are responsible for 25% of blunt trauma fatalities and contribute to an additional 50% of deaths in this population.1 Fortunately, the majority of thoracic injuries can be treated effectively, and often definitively, by relatively simple maneuvers that can be learned and performed by most physicians involved in early trauma care. Only 5 to 10% will require operative intervention.2 These extremes in injury severity are unique to the chest and require treatment by a surgeon with a correspondingly broad range of knowledge and skills.  This article will address the following procedures and injuries:  tube thoracostomy, thoracotomy, emergency department resuscitative thoracotomy, video-assisted thoracoscopy, chest wall injuries including rib fractures and flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion and laceration, and tracheobronchial injury. This review 6 figures, 1 table, and 49 references. Keywords: Tube thoracoscopy, emergency department resuscitative thoracotomy (EDRT), rib fractures, flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion, pulmonary laceration, tracheobronchial injury

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.

scholarly journals Predictive Factors of Ventilatory Support in Chest Trauma

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1154
Author(s):  
Silvia Fattori ◽  
Elisa Reitano ◽  
Osvaldo Chiara ◽  
Stefania Cimbanassi
Keyword(s):  
Predictive Factors ◽  
Thoracic Trauma ◽  
Univariate Analysis ◽  
Ventilatory Support ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

This study aims to define possible predictors of the need of invasive and non-invasive ventilatory support, in addition to predictors of mortality in patients with severe thoracic trauma. Data from 832 patients admitted to our trauma center were collected from 2010 to 2017 and retrospectively analyzed. Demographic data, type of respiratory assistance, chest injuries, trauma scores and outcome were considered. Univariate analysis was performed, and binary logistic regression was applied to significant data. The injury severity score (ISS) and the revised trauma score (RTS) were both found to be predictive factors for invasive ventilation. Multivariate analysis of the anatomical injuries revealed that the association of high-severity thoracic injuries with trauma in other districts is an indicator of the need for orotracheal intubation. From the analysis of physiological parameters, values of systolic blood pressure, lactate, and Glasgow coma scale (GCS) score indicate the need for invasive ventilatory support. Predictive factors for non-invasive ventilation include: RTS, ISS, number of rib fractures and presence of hemothorax. Risk factors for death were: age over 65, the presence of bilateral rib fractures, pulmonary contusion, hemothorax and associated head trauma. In conclusion, the need for invasive ventilatory support in thoracic trauma is associated to the patient’s systemic severity. Non-invasive ventilation is a supportive treatment indicated in physiologically stable patients regardless of the severity of thoracic injury.

scholarly journals Rib Fractures, Flail Chest, and Pulmonary Contusion

2015 ◽  
Vol 1 (4) ◽  
pp. 237-242 ◽  
Author(s):  
K. Shad Pharaon ◽  
Silvana Marasco ◽  
John Mayberry
Keyword(s):  
Flail Chest ◽  
Rib Fractures ◽  
Pulmonary Contusion

Article Commentary: Contemporary Management of Flail Chest

2014 ◽  
Vol 80 (6) ◽  
pp. 527-535 ◽  
Author(s):  
P. Geoff Vana ◽  
Daniel C. Neubauer ◽  
Fred A. Luchette
Keyword(s):  
Surgical Management ◽  
High Mortality ◽  
Inflammatory Reaction ◽  
Flail Chest ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Challenging Problem ◽  
History Of ◽  
Fractured Ribs ◽  
Contemporary Management

Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

Multiple rib fractures: does flail chest matter?

2021 ◽  
pp. emermed-2020-210999
Author(s):  
Yaakov Daskal ◽  
Maya Paran ◽  
Alexander Korin ◽  
Vladislav Soukhovolsky ◽  
Boris Kessel
Keyword(s):  
Intensive Care ◽  
Injury Severity ◽  
Medical Center ◽  
Unit Length ◽  
Flail Chest ◽  
Trauma Centre ◽  
Rib Fractures ◽  
Multiple Rib Fractures ◽  
Chest Injuries ◽  
Reliable Marker

BackgroundRecent studies have reported significant morbidity and mortality in patients with multiple rib fractures, even without flail chest. The aim of this study was to compare the clinical outcome and incidence of associated chest injuries between patients with and without flail chest, with three or more rib fractures.MethodsThis study included patients with blunt trauma with at least three rib fractures, hospitalised during 2010–2019 in the Hillel Yaffe Medical Center in central Israel (level II trauma centre). Patients with and without radiologically defined flail chest were compared with regard to demographics, Injury Severity Score (ISS), GCS, systolic blood pressure (SBP) on admission, radiological evidence of flail chest, associated chest injuries, length of stay in intensive care unit, length of hospitalisation and mortality.ResultsThe study included 407 patients, of which 79 (19.4%) had flail chest. Overall, pneumothorax and haemothorax were more common among patients with flail chest (p<0.05). When comparing patients with three to five rib fractures, there was no difference in length of intensive care and length of hospitalisation or mortality; however, there was a higher incidence of pneumothorax (24.6% vs 50.0%, p<0.05). When comparing patients with six or more rib fractures, no difference was found between patients with and without flail chest.ConclusionIn patients with three to five rib fractures, pneumothorax is more common among patients with flail chest. Clinical significance of flail chest in patients with more than six rib fractures is questionable and flail chest may not be a reliable marker for severity of chest injury in patients with more than six fractures.

scholarly journals P073: Feasibility of emergency department targeted ultrasound for rib fracture diagnosis in minor thoracic injury

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S102-S103
Author(s):  
E. Lalande ◽  
C. Guimont ◽  
M. Émond ◽  
M. Parent ◽  
B. Batomen Kuimi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Daily Practice ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Thoracic Injury ◽  
Limiting Factor ◽  
Median Score ◽  
X Ray ◽  
Targeted Ultrasound ◽  
Fracture Diagnosis

Introduction: Rib fractures represent a frequent condition associated with Minor Thoracic Injury (MTI). Since the last decade, ultrasound have become an important part of emergency physician’s (EP) daily practice, and its applications have become numerous. The main objective of this study was to evaluate the feasibility of Emergency Department Targeted Ultrasound (EDTU) for rib fracture diagnosis in patients with MTI. Secondary objectives were to 1) evaluate patients’ pain during the EDTU procedure, 2) assess clinicians’ degree of certitude over rib fracture diagnosis made by EDTU, 3) identify the limitations of the use of EDTU technique, and 4) compare the diagnosis obtained with EDTU to radiography results. Methods: Adult patients who presented with clinical suspicion of rib fractures after MTI were included. All patients underwent EDTU performed by emergency physicians (EP) prior to a rib view X-ray. Visual Analogue Scale (VAS) ranging from 0 to 100 was used to ascertain feasibility, patients’ pain and clinicians’ degree of certitude. Feasibility was defined as a score of more than 50 on the VAS. We also documented the radiologists’ interpretation of rib view X-ray. Radiologists were blinded to the EDTU results. Results: Ninety-six patients were included. A majority (65%) of EP concluded that the EDTU technique to diagnose rib fracture was feasible (VAS score > 50). Median score for feasibility was 63. Median score was 31 (Interquartile range (IQR) 5-57) for patients’ pain related to the EDTU examination and 72 (IQR 32-92) for the degree of certitude over the diagnosis made by EDTU. The main limiting factor of the EDTU technique was pain during patient examination (15%). Conclusion: EDTU examination appears to be a feasible technique for rib fractures diagnosis in the ED.

The Clinical Significance of Occult Thoracic Injury in Blunt Trauma Patients

2010 ◽  
Vol 76 (10) ◽  
pp. 1063-1066 ◽  
Author(s):  
Meghann Kaiser ◽  
Matthew Whealon ◽  
Cristobal Barrios ◽  
Sarah Dobson ◽  
Darren Malinoski ◽  
...  
Keyword(s):  
Traumatic Injury ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Included Patient ◽  
Clinical Consequences ◽  
Chest X Ray ◽  
Patient Groups ◽  
Level I

Increased use of thoracic CT (TCT) in diagnosis of blunt traumatic injury has identified many injuries previously undetected on screening chest x-ray (CXR), termed “occult injury.” The optimal management of occult rib fractures, pneumothoraces (PTX), hemothoraces (HTX), and pulmonary contusions is uncertain. Our objective was to determine the current management and clinical outcome of these occult blunt thoracic injuries. A retrospective review identified patients with blunt thoracic trauma who underwent both CXR and TCT over a 2-year period at a Level I urban trauma center. Patients with acute rib fractures, PTX, HTX, or pulmonary contusion on TCT were included. Patient groups analyzed included: 1) no injury (normal CXR, normal TCT, n = 1337); 2) occult injury (normal CXR, abnormal TCT, n = 205); and 3) overt injury (abnormal CXR, abnormal TCT, n = 227). Patients with overt injury required significantly more mechanical ventilation and had greater mortality than either occult or no injury patients. Occult and no injury patients had similar ventilator needs and mortality, but occult injury patients remained hospitalized longer. No patient with isolated occult thoracic injury required intubation or tube thoracostomy. Occult injuries, diagnosed by TCT only, have minimal clinical consequences but attract increased hospital resources.

Comparison of Surgical Stabilization Time in Patients with Flail Chest

2020 ◽  
Vol 68 (08) ◽  
pp. 743-751
Author(s):  
Hüseyin Ulaş Çınar ◽  
Burçin Çelik
Keyword(s):  
Mechanical Ventilation ◽  
Correlation Analysis ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Stabilization Time ◽  
Icu Stay ◽  
Stay Hospital

Abstract Background This study aimed to compare the clinical outcomes of early and late surgical stabilization of rib fractures (SSRFs) in patients with flail chest. Methods A retrospective analysis was performed on patients with flail chest according to surgical stabilization time of rib fractures (early [≤ 72 hours] and late [>72 hours]). Outcome measures included duration of mechanical ventilation, intensive care unit (ICU) stay, hospital stay, and morbidity and mortality rates. A correlation analysis was performed between the time from trauma to stabilization and the clinical outcomes after stabilization. Results A total of 70 patients were evaluated (36 and 34 in the early and late groups, respectively). The demographics and indicators of injury severity were comparable in both groups. The early group had significantly shorter duration of mechanical ventilation (23.7 vs. 165.6 hours; p = 0.003), ICU stay (6.5 vs. 19.7 days; p = 0.003), hospital stay (9 vs. 22.5 days; p = 0.001), and lower rate of atelectasis (11 vs. 58%; p = 0.01), pneumonia (8.8 vs. 50%; p = 0.001), and empyema (2.8 vs. 20.6%; p = 0.019). According to the correlation analysis, it was found that early surgical stabilization had a positive significant effect on clinical outcomes after stabilization. Conclusion Early SSRFs in patients with flail chest results in more favorable clinical outcomes. It should be performed as soon as possible in the presence of indication and if feasible.

Rib Fracture Location Should be Evaluated When Predicting Morbidity and Mortality in Trauma Patients

2018 ◽  
Vol 84 (9) ◽  
pp. 1462-1465 ◽  
Author(s):  
Krista L. Haines ◽  
Tiffany Zens ◽  
Charles Warner-Hillard ◽  
Edwarda DeSouza ◽  
Hee Soo Jung ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Mortality And Morbidity ◽  
Fracture Location

Rib fractures represent up to 55 per cent of thoracic blunt traumatic injuries and lead to significant mortality and morbidity. The aim of this study is to determine whether not only number but also the location of rib fractures can be used to risk stratify patients. This is a retrospective study of all blunt trauma patients who presented with rib fractures from January 1, 2013 to April 1, 2015 and underwent chest CT. Rib fractures were categorized by location. Primary outcome was mortality, secondary outcomes were total hospital length of stay (LOS), intensive care unit LOS, and disposition. Multivariate regressions were performed to determine whether mortality and morbidity was dependent on the number of rib fractures as related to location. Nine hundred and twenty-nine patients were reviewed, 669 fit inclusion criteria, and 35 patients died. Mean Injury Severity Score (18 ± 10), total number of rib fractures (6 ± 5), and age (54 ± 19) significantly correlated with mortality. LOS correlated with the number of rib fractures (P < 0.001). Flail chest of indeterminate location significantly increased mortality (P = 0.002). Controlling for age, gender, and Injury Severity Score and for every lateral rib fracture, patients were 1.13 times (OR; P = 0.001) more likely to die. Posterior rib fractures only effected patient outcome if the patient has three or more posterior ribs broken and the patient was 45 years of age or older (P = 0.044); these patients were 12 times more likely to die. When evaluating blunt force trauma in patients with rib fractures, it is imperative to look at rib fracture location and not only the number of rib fractures sustained to predict outcomes.

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