Epidemiological profile of thoracic trauma in a reference hospital of Foz do Rio Itajai

Clinical-epidemiological evaluation of victims of thoracic trauma in a reference hospital in Aracaju-SE

INTRODUCTION

thoracic trauma is defined as anything that involves the rib cage, the musculoskeletal framework that houses the heart, lungs, pleurae and mediastinal structures. It can be superficial or immediately lifethreatening for victims. In Brazil, most assistance is due to urban violence.

OBJECTIVE

evaluate the clinical and epidemiological aspect of patients who are victims of thoracic trauma treated at Hospital de Urgência de Sergipe, Aracaju/SE, Brazil.

METHOD

cross-sectional, observational and prospective study, carried out for eleven months, with 100 polytraumatized patients. A semi-structured form was applied, and the data were systematized, analyzed and statistically tested considering a 5% margin of error. Results: 85% of the patients were male, with a mean age of 39.3 and an age range of 30 to 49 years; 57% of them had incomplete primary education, 70% had a family income of up to 2 minimum wages and 41% were from Greater Aracaju. As for the mechanism of trauma, 33% were car-related, with blunt trauma as the main mechanism, and rib fractures as the main consequence. Among penetrating injuries, CWI (26%) and GSW (21%) were the most prevalent, with hemothorax being the main consequence. Most patients underwent thoracostomy (59%).

CONCLUSION

the profile found was of young men, victims of urban violence. The thoracostomy was resolving in most cases and should be instituted promptly when necessary. A smaller number of patients may require thoracotomy, especially in the presence of hemodynamic instability.

Blood Count-Derived Inflammatory Markers Correlate with Lengthier Hospital Stay and Are Predictors of Pneumothorax Risk in Thoracic Trauma Patients

(1) Background: Trauma is one of the leading causes of death worldwide, with the chest being the third most frequent body part injured after abdominal and head trauma. Identifying and predicting injuries related to the trauma mechanism is the initial step in managing significant thoracic trauma. The purpose of this study is to assess the predictive capabilities of blood count-derived inflammatory markers at admission. (2) Materials and Methods: The current study was designed as an observational, analytical, retrospective cohort study. It included all patients over the age of 18 diagnosed with thoracic trauma, confirmed with a CT scan, and admitted to the Clinical Emergency Hospital of Targu Mureş, Romania. (3) Results: The occurrence of posttraumatic pneumothorax is highly linked to age (p = 0.002), tobacco use (p = 0.01), and obesity (p = 0.01). Furthermore, high values of all hematological ratios, such as the NLR, MLR, PLR, SII, SIRI, and AISI, are directly associated with the occurrence of pneumothorax (p < 0.001). Furthermore, increased values of the NLR, SII, SIRI, and AISI at admission predict a lengthier hospitalization (p = 0.003). (4) Conclusions: Increased neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), aggregate inflammatory systemic index (AISI), and systemic inflammatory response index (SIRI) levels at admission highly predict the occurrence of pneumothorax, according to our data.

Thoracic injuries in trauma patients: epidemiology and its influence on mortality

BACKGROUND

Thoracic injuries are common among trauma patients. Studies on trauma patients with thoracic injuries have reported considerable differences in morbidity and mortality, and there is limited research on comparison between trauma patients with and without thoracic injuries, particularly in the Scandinavian population. Thoracic injuries in trauma patients should be identified early and need special attention since the differences in injury patterns among patient population are important as they entail different treatment regimens and influence patient outcomes. The aim of the study was to describe the epidemiology of trauma patients with and without thoracic injuries and its influence on 30-day mortality.

METHODS

Patients were identified through the Karolinska Trauma Register. The Abbreviated Injury Scale (AIS) system was used to find patients with thoracic injuries. Logistic regression analysis was performed to evaluate factors [age, gender, ASA class, GCS (Glasgow Coma Scale), NISS (New Injury Severity Score) and thoracic injury] associated with 30-day mortality.

RESULTS

A total of 2397 patients were included. Of those, 768 patients (32%) had a thoracic injury. The mean (± SD, range) age of all patients (n = 2397) was 46 (20, 18-98) years, and the majority (n = 1709, 71%) of the patients were males. There was a greater proportion of patients with rib fractures among older (≥ 60 years) patients, whereas younger patients had a higher proportion of injuries to the internal thoracic organs. The 30-day mortality was 11% (n = 87) in patients with thoracic injury and 4.3% (n = 71) in patients without. After multivariable adjustment, a thoracic injury was found to be associated with an increased risk of 30-day mortality (OR 1.9, 95% CI 1.3-3.0); as was age ≥ 60 years (OR 3.7, 95% CI 2.3-6.0), ASA class 3-4 (OR 2.3, 95% CI 1.4-3.6), GCS 1-8 (OR 21, 95% CI 13-33) and NISS > 15 (OR 4.2, 2.4-7.3).

CONCLUSION

Thoracic injury was an independent predictor of 30-day mortality after adjustment for relevant key variables. We also found a difference in injury patterns with older patients having a higher proportion of rib fractures, whilst younger patients suffered more internal thoracic organ injuries.

Epidemiological and clinical characteristics of road traffic crashes related thoracic traumas: analysis of 5095 hospitalized chest injury patients

BACKGROUND

Road traffic crashes related (RTCR) chest traumas remain important global public health challenge. The impact of boosting market of automobile vehicles in China during last decade on thoracic injury needs to be defined. This study aimed to review and analyze the demographic and clinical characteristics of RTCR thoracic injuries in China.

METHODS

Clinical records of patients with thoracic trauma admitted to thoracic surgery department between January 2003 and June 2020 were retrospectively retrieved and reviewed. Patients' profiles and clinical characteristics were comparatively analyzed between road traffic crashes caused injury and other injury mechanisms, and in RTCR chest trauma patients before January 2011 (2003 group), and after January 2011 (2011 group), when is considered as the beginning year of Chinese household vehicle era.

RESULTS

The study included 5095 thoracic trauma patients with mean age of 50.2 years, of whom 79.4% were male. Most of the patients (70.3%, n = 3583) had rib fractures. Associated injuries were present in 52.0% of the patients, of them 78.5% (n = 2080) were extremity fractures. Road traffic crashes accounted for 41.4% (n = 2108) of the injuries, most of them (98.0%) were related to motor vehicles. In comparison with other chest trauma mechanisms, RTCR chest injuries affected females and older males more frequently, with a higher incidence of rib fractures and sternum fractures, and higher injury severity scores (ISS) (all p < 0.05). Surgeries were required in 1495 (70.9%) patients of the RRTCR chest traumas, while the majority of non-RTCR thoracic injuries were managed conservatively or with tube thoracostomy (30.2%, n = 901). RTCR chest traumas caused longer hospital stay (13.0 ± 9.6 days vs. 11.8 ± 7.4 days, p = 0.001), higher ICU usage (30.7% vs. 19.6%, p = 0.001), higher rate of ventilator support (12.9% vs. 7.5%, p = 0.001), and higher mortalities (3.8% vs. 1.6%, p = 0.005) than that of non-RTRA chest injuries. For RTCR patients, when compared with 2003 group, 2011 group had similar patterns in terms of accident category, associated injury and treatment. However, 2011 group had more females (38.5% vs. 18.0%, p = 0.001) and older males (50.6 ± 9.7 vs. 47.9 ± 17.2, p = 0.001), with a higher ISS (18.3 ± 10.2 vs. 17.1 ± 8.9, p = 0.004), and fewer were managed with chest tubes (25.0% vs. 29.2%, p = 0.031). Clinical outcomes were not significantly different between the groups in terms of hospital length of stay, intensive care unit (ICU) usage, ICU length of stay, duration of ventilator hours and mortality. However, the 2011 group had more patients requiring ventilator support (14.4% vs. 10.6%, p = 0.011).

CONCLUSIONS

Road traffic crashes remain to be the major etiology of thoracic injuries in China, which usually affects middle-aged males, causing rib fractures with concomitant injuries frequently occurring to other organ systems. Treatments mainly include tube thoracotomy and surgical procedures. Although the clinical characteristics and outcomes of traffic accident related chest traumas are largely unchanged in spite of the rapid increasing numbers of motor vehicles, variations in the pattern of injuries by gender, age, injury severity and ventilator usage may still provide important information for targeted management.

Trauma in Curitiba: multifactorial assessment of victims admitted to a university hospital

OBJECTIVE

to describe the epidemiological profile of trauma patients admitted to a referral hospital in Curitiba (PR). Also, to investigate trauma mechanisms and to evaluate trauma severity scores.

METHODS

descriptive observational cross-sectional study. Data were collected by applying a questionnaire to victims admitted in the emergency room from December 2016 to February 2018.

RESULTS

a total of 1354 trauma victims were included in the study, of which 60% were transported by SIATE and 40% by SAMU. Regarding gender, 70% of the patients were male. The mean age was 39.48 years. About the time and day of the calls, the largest proportion was concentrated on Friday night. In relation to the mechanism of trauma, in patients transported by SIATE, the most frequent in men was motorcycle collision (34.3%), while in women was same-level fall (21.42%). In SAMU, the most frequent mechanism regardless of gender was same-level fall (20.06% and 40.66%, respectively). Analyzing the severity scores, it was observed that 95.5% of the patients were classified as mild by the Glasgow Coma Scale.

CONCLUSION

the profile of trauma victims analyzed in this large study is quite similar to what other national smaller studies have already described: young men victims of traffic accidents. Therefore, the economically active population is the most affected, reflecting in high cost to society.