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Adal O, Tareke AA, Bogale EK, Anagaw TF, Tiruneh MG, Fenta ET, Endeshaw D, Delie AM. Mortality of traumatic chest injury and its predictors across sub-saharan Africa: systematic review and meta-analysis, 2024. BMC Emerg Med 2024; 24:32. [PMID: 38413939 PMCID: PMC10900610 DOI: 10.1186/s12873-024-00951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Globally, chest trauma remain as a prominent contributor to both morbidity and mortality. Notably, patients experiencing blunt chest trauma exhibit a higher mortality rate (11.65%) compared to those with penetrating chest trauma (5.63%). AIM This systematic review and meta-analysis aimed to assess the mortality rate and its determinants in cases of traumatic chest injuries. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the data synthesis process. Multiple advanced search methods, encompassing databases such as PubMed, Africa Index Medicus, Scopus, Embase, Science Direct, HINARI, and Google Scholar, were employed. The elimination of duplicate studies occurred using EndNote version X9. Quality assessment utilized the Newcastle-Ottawa Scale, and data extraction adhered to the Joanna Briggs Institute (JBI) format. Evaluation of publication bias was conducted via Egger's regression test and funnel plot, with additional sensitivity analysis. All studies included in this meta-analysis were observational, ultimately addressing the query, what is the pooled mortality rate of traumatic chest injury and its predictors in sub-Saharan Africa? RESULTS Among the 845 identified original articles, 21 published original studies were included in the pooled mortality analysis for patients with chest trauma. The determined mortality rate was nine (95% CI: 6.35-11.65). Predictors contributing to mortality included age over 50 (AOR 3.5; 95% CI: 1.19-10.35), a time interval of 2-6 h between injury and admission (AOR 3.9; 95% CI: 2.04-7.51), injuries associated with the head and neck (AOR 6.28; 95% CI: 3.00-13.15), spinal injuries (AOR 7.86; 95% CI: 3.02-19.51), comorbidities (AOR 5.24; 95% CI: 2.93-9.40), any associated injuries (AOR 7.9; 95% CI: 3.12-18.45), cardiac injuries (AOR 5.02; 95% CI: 2.62-9.68), the need for ICU care (AOR 13.7; 95% CI: 9.59-19.66), and an Injury Severity Score (AOR 3.5; 95% CI: 10.6-11.60). CONCLUSION The aggregated mortality rate for traumatic chest injuries tends to be higher in sub-Saharan Africa. Factors such as age over 50 years, delayed admission (2-6 h), injuries associated with the head, neck, or spine, comorbidities, associated injuries, cardiac injuries, ICU admission, and increased Injury Severity Score were identified as positive predictors. Targeted intervention areas encompass the health sector, infrastructure, municipality, transportation zones, and the broader community.
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Affiliation(s)
- Ousman Adal
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Abiyu Abadi Tareke
- SLL project, COVID-19 vaccine/EPI Technical Assistant at West Gondar Zonal Health Department, Amref Health Africa in Ethiopia, Bole Sub City, Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioral Science Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabil Anagaw
- Health Promotion and Behavioral Science Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia
| | - Destaw Endeshaw
- Department of Adult Health nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Mebrat Delie
- Department of Public Health, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia
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Liu A, Nguyen J, Ehrlich H, Bisbee C, Santiesteban L, Santos R, McKenney M, Elkbuli A. Emergency Resuscitative Thoracotomy for Civilian Thoracic Trauma in the Field and Emergency Department Settings: A Systematic Review and Meta-Analysis. J Surg Res 2022; 273:44-55. [PMID: 35026444 DOI: 10.1016/j.jss.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Emergency department resuscitative thoracotomy (ED-RT) or prehospital resuscitative thoracotomy (PH-RT) is performed for trauma patients with impending or full cardiovascular collapse. This systematic review and meta-analysis analyze outcomes in patients with thoracic trauma receiving PH-RT and ED-RT. METHODS PubMed, JAMA Network, and CINAHL electronic databases were searched to identify studies published on ED-RT or PH-RT between 2000-2020. Patients were grouped by location of procedure and type of thoracic injury (blunt versus penetrating). RESULTS A total of 49 studies met the criteria for qualitative analysis, and 43 for quantitative analysis. 43 studies evaluated ED-RT and 5 evaluated PH-RT. Time from arrival on scene to PH-RT >5 min was associated with increased neurological complications and time from the initial encounter to PH-RT or ED-RT >10 min was associated with increased mortality. ISS ≥ 25 and absent signs of life were also associated with increased mortality. There was higher mortality in all PH-RT (93.5%) versus all ED-RT (81.8%) (P = 0.02). Among ED-RTs, a significant difference was found in mortality rate between patients with blunt (92.8%) versus penetrating (78.7%) injuries (P < 0.001). When considering only blunt or penetrating injury types, no significant difference in RT mortality rate was found between ED-RT and PH-RT (P = 0.65 and P = 0.95, respectively). CONCLUSIONS ED-RT and PH-RT are potentially life-saving procedures for patients with penetrating thoracic injuries in extremis and with signs of life. The efficacy of this procedure is time sensitive. Moreover, there appears to be a greater mortality risk for patients with thoracic trauma receiving RT in the PH setting compared to the ED setting. More studies are needed to determine the significance of PH-RT mortality.
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Affiliation(s)
- Amy Liu
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Jackie Nguyen
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Haley Ehrlich
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Charles Bisbee
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Luis Santiesteban
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Radleigh Santos
- Department of Mathematics, NOVA Southeastern University, Fort Lauderdale, Florida
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.
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Stolberg-Stolberg J, Katthagen JC, Hillemeyer T, Wiebe K, Koeppe J, Raschke MJ. Blunt Chest Trauma in Polytraumatized Patients: Predictive Factors for Urgent Thoracotomy. J Clin Med 2021; 10:jcm10173843. [PMID: 34501292 PMCID: PMC8432076 DOI: 10.3390/jcm10173843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: Current guidelines on urgent thoracotomy of polytraumatized patients are based on data from perforating chest injuries. We aimed to identify predictive factors for urgent thoracotomy after chest-tube placement for blunt chest trauma in a civilian setting. Methods: Polytraumatized patients (Injury Severity Score ≥16) with blunt chest trauma, submitted to a level I trauma centre during a period of 12 years that received at least one chest tube were included. Trauma mechanism, chest-tube output, haemoglobin values, need for cellular blood products, coagulopathies, rib fracture pattern, thoracotomy, and mortality were retrospectively analysed. Results: 235 polytraumatized patients were included. Patients that received urgent thoracotomy (UT, n = 10) showed a higher mean chest-tube output within 24 h with a median (Mdn) of 3865 (IQR 2423–5156) mL compared to the group with no additional thoracic surgery (NT, n = 225) with Mdn 185 (IQR 50–463) mL (p < 0.001). The cut-off 24-h chest-tube output value for recommended thoracotomy was 1270 mL (ROC-Curve). UT showed an initial haemoglobin of Mdn 11.7 (IQR 9.2–14.3) g/dL and an INR value of Mdn 1.27 (IQR 1.11–1.69) as opposed to Mdn 12.3 (IQR 10–13.9) g/dL and Mdn 1.13 (IQR 1.05–1.34) in NT (haemoglobin: p = 0.786; INR: p = 0.215). There was an average number of 7.1(±3.4) rib fractures in UT and 6.7(±4.8) in NT (p = 0.649). Conclusions: Chest-tube output remains the single most important predictive factor for urgent thoracotomy also after blunt chest trauma. Patients with a chest-tube output of more than 1300 mL within 24 h after trauma should be considered for transfer to a level I trauma centre with standby thoracic surgery.
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Affiliation(s)
- Josef Stolberg-Stolberg
- Department of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, Germany; (J.C.K.); (M.J.R.)
- Correspondence: ; Tel.: +49-251-83-59231
| | - Jan Christoph Katthagen
- Department of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, Germany; (J.C.K.); (M.J.R.)
| | - Thomas Hillemeyer
- Department of Anesthesiology, Intensive Care, and Pain Medicine, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building A1, 48149 Muenster, Germany;
| | - Karsten Wiebe
- Section of Thoracic Surgery and Lung Transplantation, Department of Cardiothoracic Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building A1, 48149 Muenster, Germany;
| | - Jeanette Koeppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany;
| | - Michael J. Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, Germany; (J.C.K.); (M.J.R.)
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Mazcuri M, Ahmad T, Abid A, Thapaliya P, Ali M, Ali N. Pattern and Outcome of Thoracic Injuries in a Busy Tertiary Care Unit. Cureus 2020; 12:e11181. [PMID: 33133801 PMCID: PMC7593122 DOI: 10.7759/cureus.11181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Thoracic traumas are one of the most commonly encountered injuries in the emergency room. They range from blunt chest injuries due to road traffic accidents to penetrating chest injuries. Immediate medical and surgical interventions are essential to improve the outcome. This study was conducted to assess the pattern of thoracic trauma presenting to the emergency room, their outcome and factors contributing to it. METHODS This prospective, observational, cross-sectional study was conducted in the Department of Thoracic Surgery, Jinnah Post Graduate Medical Center, Karachi from January 1 until July 31, 2020, with institutional ethical approval. Patients age ≥12 years presenting with traumatic thoracic injury with or without associated injuries were included. Characteristics of their injuries and management outcome were studied. All data was processed through Statistical Package for Social Sciences (SPSS) Statistics version 22 (IBM Corp., Armonk, NY, USA). RESULTS A total of 199 patients were included; 154 (77.4%) patients were male and 45 (22.6%) patients were female. The most common age group presenting with trauma was the middle age (30-60 years), which included 101 (50.8%) patients. Out of the total, 126 (63.3%) had blunt chest injuries and 73 (36.6%) had penetrating chest injuries. Road traffic accidents were the most common cause of blunt chest injuries seen in 83 (65.8%) patients, whereas gunshot was the most common mode of penetrating chest injuries encountered in 41 (56.2%) cases. Tube thoracostomies were performed in 166 (83.4%) patients and thoracotomies in seven (3.51%) patients. Out of the total, 57 (28.6%) patients required mechanical ventilation and it was associated with blunt trauma, hemothorax, rib fracture, abdominal and head injuries (p ≤0.05). Mortality was seen in 22 (11.1%), which was associated with hemothorax, head injuries, mechanical ventilation and severe blood loss (p ≤0.05). CONCLUSION Traumatic thoracic injuries are a preventable cause of mortality. Blunt chest injuries are more common than penetrating chest injuries. Proper implementation of public safety measures ensures less frequent and severe outcomes. Emergency department team and specialized thoracic surgeons must come together to manage these critical patients with utmost care.
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Affiliation(s)
- Misauq Mazcuri
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Tanveer Ahmad
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Ambreen Abid
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Mansab Ali
- General Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Nadir Ali
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol 2020; 23:125-138. [PMID: 32417043 PMCID: PMC7296362 DOI: 10.1016/j.cjtee.2020.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/15/2020] [Accepted: 04/08/2020] [Indexed: 02/04/2023] Open
Abstract
Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.
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