Pattern and In-Hospital Mortality of Thoracoabdominal Injuries Associated with Motor Vehicle Accident-Related Spinal Injury: A Retrospective Single-Center Study

Background. Motor vehicle accident (MVA) is a global health hazard that results in spinal, thoracic, and abdominal injuries. Detailed studies on the association between MVA-related traumatic spinal injury (TSI) and thoracoabdominal injuries are lacking. This study aims to elucidate the prevalence, pattern of association between these injuries, and related outcomes in terms of in-hospital mortality. Methods. This is a retrospective single-center study of MVA-related TSI with thoracoabdominal associated injuries. Descriptive analysis was performed for gender, age, spinal injury level, thoracoabdominal injury region, admission day, hospital stay duration, and discharge category. The association between TSI and thoracoabdominal injury was analyzed, and the chi-square test was used to test the significance of differences. A statistically significant difference was considered at P values less than 0.05. Results. The cohort had a mean age of 33.6 ± 17.7 years with predominantly more males (85.1%). Thoracoabdominal injuries were present in 10.5% of MVA-related TSIs, and 9.2% of victims died during their hospital stay. There is a significant ( P = 0.045 ) association between the level of the spinal and the region of thoracoabdominal injuries. The presence of TSI-associated thoracic injury significantly ( P = 0.041 ) correlated with increased in-hospital mortality more than abdominal injury. Conclusion. Thoracoabdominal injuries concomitant with MVA-related TSI cause considerable mortality. A pattern of association exists between the level of spinal and region of thoracoabdominal injury. Knowledge of this pattern is helpful in the routine practice of trauma health partitioners.

Iatrogenic Pneumopericardium after tube thoracostomy: Case Report

Background: Pneumopericardium, the presence of air within the pericardial space, is a rare occurrence which usually follows positive pressure ventilation in infants, or blunt and penetrating thoracoabdominal injuries in adults. The occurrence of iatrogenic pneumopericardium following tube thoracostomy is an extremely rare occurrence.Case presentation: We present a rare case of iatrogenic pneumopericardium in a 1 year and 7 months old female child for whom a left side tube thoracostomy was done using nasogastric tube for an indication of left empyema thoracis. Later, she developed progressive worsening of shortness of breath and imaging revealed iatrogenic pneumopericardium. She was managed conservatively and discharged home in good condition.Discussion: Pneumopericardium can have a range of presentations from being asymptomatic to presenting with features of cardiac tamponade. Treatment can range from conservative observation to pericardiocentesis and insertion of a small chest tube into the pericardium. In the absence of echocardiographic evidence of tamponade, the severe malnutrition our patient had and the already infected pleural cavity which could have increased her postoperative complication we deferred surgical intervention.Conclusion: Iatrogenic pneumopericardium is a rare event but it might lead to death if not diagnosed and treated promptly. Although reporting of complications is not popular, this represents an opportunity to advance the safety during chest drain insertion. The tendency to develop tension pneumopericardium urging surgical intervention is high in pediatric patients but our patient has improved well with conservative management.

Anatomical-functional scale of estimation of the trauma severity in wounded persons with thoracoabdominal injuries in environment of conduction of The Joint Armed Forces Operation

Objective. To determine the trustworthiness of the elaborated anatomic-functional scale for the trauma severity estimation (Admission trauma scale) in the wounded persons with thoraco-abdominal injuries, evacuated on the level II medical service. Materials and methods. Retrospective analysis was conducted, concerning 123 wounded persons with the gun-shot thoraco-abdominal injuries, obtained while conduction of The Joint Forces Operation. The trauma severity was determined in accordance to anatomic-functional scale (Admission trauma scale). Results. Statistical analysis was conducted concerning the point characteristic estimation in accordance to anatomic-functional scale of the general massive of the observation. Estimation in accordance to anatomic-functional scale for the wounded persons, who have survived, constituted at average (6.9 ± 2) points, while for the wounded persons, who have died, – (12.4 ± 15) points. Then, a value of the confidence interval was determined in accordance to formula M ± 3δ. Of 123 wounded persons with thoraco-abdominal injuries in 107 (87%) the state of severity estimation in accordance to anatomic-functional scale did not cross the interval of trustworthiness borders. Conclusion. Anatomic-functional scale for the trauma severity estimation permits to determine the organization of treatment peculiarities in the surgical help delivery on initial stages of medical evacuation, and, taking into account of this procedure simplicity, its application is possible without application of additional methods of examination.

Higher Mortality Rate in Moderate-to-Severe Thoracoabdominal Injury Patients with Admission Hyperglycemia Than Nondiabetic Normoglycemic Patients

Background: Hyperglycemia at admission is associated with an increase in worse outcomes in trauma patients. However, admission hyperglycemia is not only due to diabetic hyperglycemia (DH), but also stress-induced hyperglycemia (SIH). This study was designed to evaluate the mortality rates between adult moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia as DH or SIH and in patients with nondiabetic normoglycemia (NDN) at a level 1 trauma center. Methods: Patients with a glucose level ≥200 mg/dL upon arrival at the hospital emergency department were diagnosed with admission hyperglycemia. Diabetes mellitus (DM) was diagnosed when patients had an admission glycohemoglobin A1c ≥6.5% or had a past history of DM. Admission hyperglycemia related to DH and SIH was diagnosed in patients with and without DM. Patients who had a thoracoabdominal Abbreviated Injury Scale score <3, a polytrauma, a burn injury and were below 20 years of age were excluded. A total of 52 patients with SIH, 79 patients with DH, and 621 patients with NDN were included from the registered trauma database between 1 January 2009, and 31 December 2018. To reduce the confounding effects of sex, age, comorbidities, and injury severity of patients in assessing the mortality rate, different 1:1 propensity score-matched patient populations were established to assess the impact of admission hyperglycemia (SIH or DH) vs. NDN, as well as SIH vs. DH, on the outcomes. Results: DH was significantly more frequent in older patients (61.4 ± 13.7 vs. 49.8 ± 17.2 years, p < 0.001) and in patients with higher incidences of preexisting hypertension (2.5% vs. 0.3%, p < 0.001) and congestive heart failure (3.8% vs. 1.9%, p = 0.014) than NDN. On the contrary, SIH had a higher injury severity score (median [Q1–Q3], 20 [15–22] vs. 13 [10–18], p < 0.001) than DH. In matched patient populations, patients with either SIH or DH had a significantly higher mortality rate than NDN patients (10.6% vs. 0.0%, p = 0.022, and 5.3% vs. 0.0%, p = 0.043, respectively). However, the mortality rate was insignificantly different between SIH and DH (11.4% vs. 8.6%, odds ratio, 1.4; 95% confidence interval, 0.29–6.66; p = 0.690). Conclusion: This study revealed that admission hyperglycemia in the patients with thoracoabdominal injuries had a higher mortality rate than NDN patients with or without adjusting the differences in patient’s age, sex, comorbidities, and injury severity.

Regarding operative treatment of thoracoabdominal injuries

Aim. To improve the results of treatment in patients with thoracoabdominal injuries (TAI) by means of creating the method of determining indications for the use of classical or endoscopic surgeries in respect of this pathology. Materials and methods. Seventy-six sufferers from TAI were divided into 2 groups. Results. The method of successive determination of indications for the use of classical or endoscopic surgeries in patients with TAI was created on the basis of treatment of 41 (53.95 %) patients of group II. This method was used to treat 35 (46.05 %) patients of group I. Conclusions. Rational approach to the choice between the use of advantages of classical and endoscopic surgeries depending on characteristics of clinical situation permitted to elevate the quality of treatment in patients with TAI.