Thoracic trauma: an analysis of 187 patients

Acta Chir Belg. 2001 Nov-Dec;101(6):277-82.

Abstract

A retrospective analysis of 187 cases of thoracic trauma seen between January 1, 1994 and June 30, 1999 is presented. The majority of the patients were male (male-female ratio 2.9:1) and the average age at admission was 41.1 years. Blunt trauma, especially motor vehicle accidents (72.2%) and falls (17.1%), were the most frequent causes of chest injury (95.8%). We used the injury severity score (ISS) to assess the severity of trauma. The average ISS for the total group was 27.8 (ranges: 4-75). In only 17.6% of the patients an isolated thoracic trauma was present. Rib fractures (n = 133), pulmonary contusion (n = 110), pneumothorax (n = 78) and haemothorax (n = 65) were the most frequent lesions. Most patients (97.9%) were admitted to the intensive care department. A minority of the patients required thoracotomy (n = 19, 10.2%). Main indications for thoracotomy were pulmonary laceration (n = 5), aortic rupture (n = 3) and rupture of the diaphragm (n = 3). For the majority of cases, observation and/or tube thoracostomy (52.4%) and/or mechanical ventilation (61.0%) were sufficient. Pneumonia and adult respiratory distress syndrome were the most common complications (38.0 and 7.0% respectively). The overall mortality rate was 16.6%. Main causes of death were intracranial hypertension, sepsis combined with multiple organ failure, and hypovolaemic shock. For patients who did not survive the average ISS was 40.3. In a survival analysis the ISS was found to be the most significant determining survival (p < 0.0001), followed by neurotrauma (p = 0.05). Mortality after thoracic trauma remains relatively high, especially in case of associated neurotrauma. The ISS is a valuable score for assessing the severity of trauma and predicting outcome.

MeSH terms

  • Accidental Falls / statistics & numerical data
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aortic Rupture / epidemiology
  • Child
  • Child, Preschool
  • Diaphragm / injuries
  • Female
  • Humans
  • Injury Severity Score*
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Rib Fractures / epidemiology
  • Rupture
  • Thoracic Injuries / epidemiology*
  • Thoracic Injuries / mortality
  • Thoracic Injuries / surgery
  • Thoracotomy
  • Wounds, Nonpenetrating / epidemiology
  • Wounds, Nonpenetrating / mortality
  • Wounds, Nonpenetrating / surgery
  • Wounds, Penetrating / epidemiology
  • Wounds, Penetrating / mortality
  • Wounds, Penetrating / surgery