Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center

Purpose: This study aimed to investigate the characteristics of elderly patients who visited a non-regional trauma center to examine the effects of old age on the clinical outcomes of patients.Methods: The medical charts of 159 patients with trauma who visited the National Health Insurance Service Ilsan Hospital between March 2020 and February 2022 were retrospectively analyzed.Results: Of the 159 patients, 41 were assigned to the elderly patient group (EPG) and 118 were assigned to the non-elderly patient group (NEPG). The average age of patients in each group was 75.5 and 38.2 years in the EPG and the NEPG, respectively. Comparing the injury mechanism between the two groups, pedestrian traffic accidents (TA) were the most common (24.4%), followed by slipping (19.5%), motorcycle TA, and bicycle TA (14.6%) in EPG. In the NEPG, motorcycle TA (28.0%) was the most common, followed by car TA (27.1%), and fall injury (16.9%), with a significant difference between the two groups (<i>p</i> < 0.001). The significant differences between the two groups were the injury severity score (ISS; <i>p</i> = 0.004), severe trauma (<i>p</i> = 0.045), intensive care unit admission (<i>p</i> = 0.028), emergency operation (<i>p</i> = 0.034), and mortality (<i>p</i> = 0.013). The statistically significant risk factors for mortality were old age (<i>p</i> = 0.024) and chest injury (<i>p</i> = 0.013).Conclusion: Patients in the EPG compared with the NEPG group showed different injury mechanisms. The EPG has a higher severity and mortality rate than the NEPG.

The Impact of Body Mass Composition on Outcome in Multiple Traumatized Patients—Results from the Fourth Thoracic and Third Lumbar Vertebrae: A Single-Center Retrospective Observational Study

Background: Body mass composition (BC) was shown to correlate with outcome in patients after surgery and minor trauma. As BC is assessed using computed tomography (CT) and routinely applied in multiple trauma (MT), this study will help to analyze whether BC variables also correlate with outcome in trauma patients. Materials and Methods: Inclusion criteria were MT (Injury Severity Score (ISS) > 15) and whole-body CT (WBCT) scan on admission. Muscle and fat tissue were assessed at the level of the fourth thoracic vertebra (T4) and the third lumbar vertebra (L3) using Slice-O-matic software, version 5.0 (Tomovision, Montreal, QC, Canada). Univariate and multivariate regression models were used with regard to outcome parameters such as duration of ventilation, hospital stay, local (i.e., pneumonia, wound infection) and systemic (i.e., MODS, SIRS) complications, and mortality. Results: 297 patients were included. BC correlated with both the development and severity of complications. Skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI) at both T4 and L3 correlated positively with the occurrence of systemic infections. Local infections positively correlated with SMI at T4. Low muscle mass and high visceral adipose tissue (VAT) predicted the severity of systemic and local complications. Muscle tissue markers at both T4 and L3 predicted the severity of complications in roughly the same way. Moreover, higher muscle mass at the L3 level was significantly associated with higher overall survival, while SATI at the T4 level correlated positively with hospital stay, length of stay in the ICU, and duration of ventilation. Conclusions: A lower muscle mass and a high adipose tissue index are associated with a poor outcome in MT. For the first time, it was shown that BC at the fourth thoracic vertebra is associated with comparable results to those found at the third lumbar level.

Obesity and outcomes in trauma - a systematic review and meta-analysis

BACKGROUND

The physiological abnormalities relating to obesity and metabolic syndrome can contribute to worse outcomes following trauma especially in class 2 and 3 obesity. The aim of this systematic review was to determine whether patients with a higher class of obesity who suffer traumatic injury have a higher risk of worse outcomes including in-hospital mortality than normal-weight patients.

METHODS

A systematic search of MEDLINE, EMBASE, CENTRAL, Web of Science and CINAHL was performed for studies that reported a comparison of in-hospital obesity-related outcomes against normal-weight individuals aged 15 years and older following trauma. Single or multiple injuries from either blunt and/or penetrating trauma were included. Burn-related injuries, isolated head injury and studies focusing on orthopaedic related perioperative complications were excluded.

RESULTS

The search yielded 7405 articles; 26 were included in this systematic review. 945,511 patients had a BMI>30. A random-effects meta-analysis was performed for analysis of all four outcomes. Patients with class 3 obesity (BMI>40) have significantly higher odds of in-hospital mortality than normal-BMI individuals following blunt and penetrating trauma (OR, 1.75; 95% CI, 1.39-2.19, p=<0.00001), significantly longer hospital LOS (SMD, 0.23; 95% CI, 0.21-0.25; p<0.00001) and significantly longer ICU LOS (SMD, 0.19; 95% CI, 0.12-0.26; p<0.0001). In contrast, studies that examined blunt and penetrating trauma and classified obesity with a threshold of BMI>30 found no significant difference in the odds of in-hospital mortality (OR, 0.94; 95% CI, 0.86-1.02, p=0.13).

CONCLUSIONS

There is a higher risk of in-hospital mortality in patients living with class 3 obesity following trauma when compared with individuals with normal BMI. The management of patients with obesity is complex and trauma systems should develop specific weight related pathways to manage and anticipate the complications that arise in these patients. Systematic review registration number PROSPERO registration: CRD42021234482 Level of Evidence: Level 3.

Risk of Pneumonia in Pediatric Patients Following Minor Chest Trauma: A Population-Based Retrospective Cohort Study

This study investigated the association between minor chest trauma and the risk of pneumonia among pediatric patients in a Taiwanese health care setting. For this retrospective population-based cohort study, the Longitudinal Health Insurance Database was used to analyze the data of patients with a minor chest injury between 2010 and 2012. Data were analyzed through a multivariate analysis with a multiple Cox regression model. Patients were divided into a chest trauma group (n = 6592) and a non-chest trauma group (n = 882,623). An increased risk of pneumonia was observed in the chest trauma group (hazard ratio = 1.23; 95% confidence interval = 1.02–1.49) compared to the non-chest trauma group. In conclusion, this population-based cohort study demonstrated that pediatric patients with minor chest trauma are at an increased risk of pneumonia. The short-term adverse effects of pneumonia could be severe when a patient suffers from mild chest trauma.

New Diagnostic and Therapeutic Approaches for the Care of the Severely Injured Patient

Severe trauma remains a leading cause of death, especially in the younger population [...].