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... ©2015 Whizar-Lugo et al. Flail chest: The flail chest is an uncommon lesion that usually occurs with a high speed vehicular accident. It is commonly characterized by three or more rib fractures in two or more sites, with or without sternal lesion [13] where the injured segment of the thoracic wall show paradoxical respiratory movement, mechanical respiratory dysfunction, and frequent respiratory failure. 75% of the cases are associated with pulmonary contusion, which produces an inflammatory response with right to left shunts, resulting in severe hypoxia, severe pulmonary restriction with the need of tracheal intubation and pulmonary ventilation. Morbidity and mortality are high. The study by Dehghan et al. [14] with 3,467 cases with flail thorax; of which 75% were men, 15% had head injuries, and 54% had pulmonary contusions. Only 0.07% had surgical fixation of the thoracic wall and 8% had epidural analgesia, 44% were placed a pleural catheter, 21% required tracheostomy, 59% required mechanical ventilation, and 82% were in the ICU for an average of 11.7 days. 21% of the patients had complications due to pneumonia, adult respiratory distress syndrome in 14%. It is important to mention that only 7% had sepsis and 16% died. The treatment is based on analgesia, an aggressive pulmonary hygiene including frequent tracheobronchoscopy, pulmonary physiotherapy especially with hypoxemia chest wall instability means ventilatory problems with tracheal intubation or early tracheostomy [15]. Surgical fixation in costal rib fractures continue to be controversial. Bottlang et al. [16] used anatomic plates and intramedullary splints in patients with severe damage level of 28±10 with broken ribs 8.5±2.9 with good results. These authors have stated that patients reached an 84% force vital capacity at three months and 50% returned to work at six months. In this trial, there were no deaths. A systematic review and meta-analysis [17] that includes nine small studies with a total of 538 patients compared the results of non-surgical vs. surgical treatment. The latter treatment was associated with less time on mechanical ventilation support, less pneumonias, less tracheostomies, and a lower mortality rate. A similar study with 753 patients [18] shared similar results, suggesting that the surgical fixation of rib fractures have significant benefits. This treatment had meaningful results, suggesting that the surgical fixation of the fractured ribs could lead to significant benefits. On the other hand, Cataneo et al. [19] found evidence in three studies with flail chest patients that non-surgical treatment is better than surgical management. They found fewer cases with pneumonia, thoracic deformities, tracheostomy incidence, mechanical ventilation and their ICU duration ( Figure 3). Pulmonary lesions: This type of lesions can be moderate to severe with imminent death. The clinical skills during pre-hospital care and in the emergency room are essential to determine if there is pulmonary damage as described in the following ...
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Citations
... 2 Chest trauma is a condition that has worsened along with growing urbanization and industrialization. 3 It is the third most important cause of mortality and morbidity preceded by cancer and cardiovascular diseases worldwide. 4,5 Chest trauma is responsible for 10% of all trauma admissions and 25% of trauma-related deaths globally. ...
Purpose:
Injury continues to be an important cause of morbidity and mortality in both developed and developing countries. Globally, it is responsible for approximately 5.8 million deaths per year and 91% of these deaths occur in developing countries. Road traffic collision, suicides and homicides are the leading cause of traumatic deaths. Despite the fact that traumatic chest injury is being responsible for 10% of all trauma-related hospital admissions and 25% of trauma-related deaths across the world including in Ethiopia, only few published studies showed the burden of traumatic chest injury in Ethiopia. So, this study aimed at assessing the characteristics and outcome of traumatic chest injury patients visited Tikur Anbesa Specialized Hospital (TASH) over one year period.
Methods:
A single center based retrospective study was done. We collected data from patients' records to assess characteristics and outcome of traumatic chest injury at TASH over one year period. All patients diagnosed with traumatic chest injury and received treatment at the hospital from January 1 to December 31, 2016 regardless of its types and severity levels were included to the study. Patients with incomplete medical records for at least 20% of the study variables and without detailed medical history, or patients died before receiving any health care were excluded from the study. The collected data were cleaned and entered into Epidata version 3.1 and exported to SPSS Version 21.0 for analysis. Bivariate and multivariate logistic regression models were used to examine factors associated with outcome of traumatic chest injury patients.
Results:
A total of 192 chest injury patients were included in the study and about one-fourth of chest injury victims were died during treatment period in TASH. Road traffic collision (RTC) was the leading cause of morbidity and mortality among traumatic chest injury victims. Age of the victims (Adjusted odds ratio (AOR) 8.9, 95% CI 1.51-53.24), time elapsed between the occurrence of traumatic chest injury and admission to health care facilities (AOR 4.6, 95% CI 1.19-18.00), length of stay in hospital (AOR 0.12, 95% CI 0.02-0.58), presence of multiple extra-thoracic injury (AOR 25, 95% CI 4.18-150.02) and development of complications (AOR 23, 95% CI10-550)were factors associated with death among traumatic chest injury patients in this study.
Conclusion:
RTC contributed for a considerable number of traumatic chest injuries in this study. Old age, delay in delivering the victim to health care facilities, length of stay in hospital, and development of atelectasis and pneumonia were associated with death among traumatic chest injury patients. Road safety interventions, establishment of organized pre-hospital services, and early recognition and prompt management of traumatic chest injury related complications are urgently needed to overcome the underlying problems in the study setting.
The challenge in caring for patients who sustain traumatic chest injuries centers on their complex needs from high acuity and the potential for multisystem effects and complications. Hemorrhage and respiratory compromise are common sequela of thoracic trauma. Patients must be resuscitated and their injuries managed with the primary goals of restoring cardiopulmonary structural integrity and preventing complications. There are evolving strategies for the management of the thoracic trauma victim including damage control resuscitation and surgery, endovascular repairs, and assessments implementing severity scores to aid in planning interventions.
Anaesthetists play an important role in the evaluation and treatment of patients with signs of thoracic trauma. Anaesthesia involvement can provide valuable input using both advanced diagnostic and therapeutic interventions. Commonly performed interventions may be complicated in this setting including airway management, damage control resuscitation, and acute pain management. Anaesthetists must consider additional factors including airway injuries, vascular injuries, and coagulopathy when treating this population. This evidence-based review discusses traumatic thoracic injuries with a focus on new interventions and modern anaesthesia techniques. This review further serves to support the early involvement of anaesthetists in the emergency department and other areas where they can provide value to the trauma care pathway.
Background
Traumatic chest injury is responsible for 10%-15% of all trauma-related hospital admissions across the world. It is also responsible for approximately 25% of trauma related death. Several predictors have been described for mortality following chest trauma however, limited published studies were available in Ethiopia.
Objective
To assess mortality rate and factors associated with death in traumatic chest injury patients over five year’s period from June, 2016 to June 30, 2020 G.C.
Method
A retrospective cross-sectional study was done from June 2016 to June 30, 2020. Data was collected from patients’ chart. The collected data was entered into Epi-info version 7 and transferred to SPSS version 20.0 for processing and analysis. Bivariable and multivariable logistic regression was used to show factors associated with mortality. P- Value <0.05 was considered statistically significant.
Result
A total of 419 patient charts were eligible for this study. The majority of patients (55.8%) sustained blunt chest injuries and violence (52.5%) was the leading cause of injuries. Hemopneumothorax (27.7.0%), hemothorax (22.9%) and rib fracture (17.2%% were the most common type of injuries. Associated extra-thoracic injuries were noted in 70.4% of patients, from those, extremity injury (22.2%), head/neck injuries (21.7%) and abdominal injuries (18.1%) were the commonest. Most patients (64.7%) were treated successfully with chest tube. Nearly, one third (35.3%) had complications including pneumonia (13.8%) and Atelectasis (12.6%). The mean length of hospital stay was 9.40 days. The overall traumatic chest injury mortality rate was 26%. Mortality was significantly associated with age >50 year [AOR 9.32, 95% CI, 2.72-31.86], late presentation beyond 6hr (AOR 7.17, 95% CI 1.76-29.21), bilateral chest injury (AOR 3.58 95% CI 1.53-8.38), penetrating chest injury (AOR 3.63 95% CI 1.65-7.98), presence of extra-thoracic injury (AOR 4.80, 95% CI, 1.47-15.72) and need for mechanical ventilation (AOR 11.18, 95% CI 2.11-59.23).
Conclusion
The mortality rate in traumatic chest injury was high. Late presentation beyond 6hr, age >50-year, penetrating injury, bilateral chest injury, associated extra thoracic injury, and need for mechanical ventilation were identified as possible risk factors for mortality in traumatic chest injury patients.
Objective:
to describe the epidemiological profile of thoracic trauma in the region of Foz do Rio Itajai, in the state of Santa Catarina, Brazil.
Methods:
observational, descriptive and prospective study performed through the collection of data starting with a form elaborated by researchers and filled in by the team in charge of a reference hospital between June 2017 and May 2018.
Results:
one hundred and nineteen forms from victims of thoracic trauma were analyzed, constituted of 70.5% male patients and 29.4% female patients, with an average of 39.8 years of age. Medical care happened mainly in daytime (67.9%), 30.2% of patients arriving by their own means, and 52.9% of patients one hour after suffering trauma. As to admission exams, most victims only went through chest X-ray (67.2%). There was a prevalence of closed thoracic trauma (89%), whose main cause was motorcycle accidents (35.2%) and the predominant lesion was rib fracture (42%). Most patients (53.8%) went through a conservative treatment. The average admission time was 2.6 days and the death rate was 5%.
Conclusion:
the profile of patients with thoracic trauma in Itajai comprises young men, admitted during the day, most of them presenting rib fracture, with closed thoracic trauma due to a road traffic accident involving a motorcycle. Chest X-ray were used to confirm most of the diagnoses, and there was a prevalence for conservative treatment. The admission time and the death rate were smaller than those cited in medical literature, which can be explained by the high index of exclusive muscular lesions.
