Background
Methods
Study design
Inclusion criteria in the study
Data collection
Statistical analysis
Results
Part I: Patient demographics
Mean | Standard deviation | |
---|---|---|
Age
| 46.1 | 19.7 |
ISS
| 30.6 | 12.6 |
Days of ventilation
| 7.3 | 11.5 |
Days admission to ICU
| 11.7 | 14.1 |
Days admission to hospital
| 25.3 | 25.0 |
Mean RR on admission
| 116.7 | 34.8 |
Mechanism of injury
Percent of study population | |
---|---|
Car passenger
| 35.6 |
Motorcyclist
| 16.5 |
Cyclist
| 6.5 |
Pedestrian
| 7.3 |
Fall >3 m
| 19.6 |
Fall <3 m
| 7.3 |
Others
| 5.0 |
Total
|
100
|
Mortality after blunt thoracic trauma is influenced by age and gender
Age | Survived | Died | Total |
---|---|---|---|
< 55 years
| 13055 | 2034 | 15089 |
86.5% | 13.5% | 100% | |
55-64 years
| 2301 | 429 | 2730 |
84.3% | 15.7% | 100% | |
65-74 years
| 1953 | 616 | 2569 |
76.0% | 24.0% | 100% | |
≥75 years
| 1336 | 889 | 2225 |
60.0% | 40.0% | 100% | |
Total
| 18645 | 3968 | 22613 |
82.5% | 17.5% | 100% |
Survived | Died | Total | |
---|---|---|---|
Female
| 4525 | 1166 | 5691 |
79.5% | 20.5% | 100% | |
Male
| 13998 | 2773 | 16771 |
83.5% | 16.5% | 100% | |
Total
| 18523 | 3969 | 22462 |
82.5% | 17.5% | 100% |
Influence of extrathoracic injuries on mortality
Head | Abdomen | Extremity | |||||||
---|---|---|---|---|---|---|---|---|---|
AIS | Survived | Died | Total | Survived | Died | Total | Survived | Died | Total |
0
| 7295 | 1034 | 8239 | 10558 | 2284 | 12842 | 4771 | 1306 | 6077 |
87.6% | 12.4% | 100% | 82.2% | 17.8% | 100% | 78.5% | 21.5% | 100% | |
1
| 1331 | 64 | 1395 | 54 | 3 | 57 | 352 | 38 | 390 |
95.4% | 4.6% | 100% | 94.7% | 5.3% | 100% | 90.3% | 9.7% | 100% | |
2
| 2509 | 196 | 4027 | 4123 | 497 | 4620 | 6359 | 949 | 7308 |
92.8% | 7.2% | 100% | 89.2% | 10.8% | 100% | 87.0% | 13.0% | 100% | |
3
| 3521 | 506 | 4027 | 2208 | 427 | 2635 | 5164 | 872 | 6036 |
87.4% | 12.6% | 100% | 83.8% | 16.2% | 100% | 85.6% | 14.4% | 100% | |
4
| 2504 | 519 | 3012 | 1168 | 396 | 1564 | 1707 | 535 | 2242 |
82.8% | 17.2% | 100% | 74.7% | 25.3% | 100% | 76.1% | 23.9% | 100% | |
5
| 1441 | 1437 | 2878 | 532 | 355 | 887 | 292 | 268 | 560 |
50.1% | 49.9% | 100% | 60.0% | 40.0% | 100% | 52.1% | 47.9% | 100% | |
6
| 44 | 212 | 256 | 2 | 6 | 8 | n.a. | n.a. | n.a. |
17.2% | 82.8% | 100% | 25.0% | 75.0% | 100% |
Prevalence of thoracic injuries in the study group
Injury | n = (% of patients) |
---|---|
Lung contusion | 10864 (48%) |
Pneumothorax | 8878 (39%) |
Rib fractures | 7794 (35%) |
Hemothorax | 6223 (28%) |
Flail chest | 3681 (16%) |
Lung laceration | 2644 (12%) |
Sternal fracture | 1947 (8%) |
Thoracic vessel injuries | 633 (3%) |
Cardiac injury | 171 (0.8%) |
Part II: Influence of thoracic injuries on survial
Regression coefficient B | Significance p= | Exp(B) = odds ratio | 95% CI for OR | ||
---|---|---|---|---|---|
Upper | Lower | ||||
Thoracic vessel injuries | .000 | ||||
Vessel injuries AIS 2 | .554 | .310 | 1.740 | .597 | 5.071 |
Vessel injuries AIS 3 | .913 | .000 | 2.492 | 1.522 | 4.081 |
Vessel injuries AIS 4 | -.020 | .927 | .980 | .634 | 1.513 |
Vessel injuries AIS 5
|
1.683
|
.000
|
5.382
|
3.669
|
7.894
|
Vessel injuries AIS 6
|
2.864
|
.000
|
17.531
|
7.688
|
39.976
|
Lung contusions | .000 | ||||
Unilateral minor (AIS 2) | -.577 | .000 | .562 | .474 | .665 |
Unilateral major (AIS 3) | -.264 | .000 | .768 | .682 | .865 |
Bilateral (AIS 4)
|
.374
|
.000
|
1.454
|
1.226
|
1.723
|
Lung lacerations | .000 | ||||
Unilateral minor (AIS 3) | -.280 | .015 | .756 | .603 | .948 |
Unilateral major or bilateral minor (AIS 4) | -,103 | ,290 | ,902 | ,745 | 1,092 |
Bilateral major (AIS 5)
|
1,114
|
,000
|
3,047
|
2,061
|
4,505
|
Rib fractures | ,000 | ||||
One rib (AIS 1) | -,018 | ,895 | ,983 | ,758 | 1,273 |
Two ribs (AIS 2) | -,558 | ,000 | ,572 | ,467 | ,702 |
Three or more (AIS 3) | -,338 | ,000 | ,713 | ,630 | ,808 |
Flail chest | ,000 | ||||
Unilateral minor (AIS 3) | -,089 | ,374 | ,914 | ,751 | 1,114 |
Unilateral minor (AIS 3) | -,091 | ,408 | ,913 | ,737 | 1,132 |
Bilateral (AIS 5)
|
,530
|
,000
|
1,698
|
1,401
|
2,059
|
Patient age | ,000 | ||||
Age 55-64
|
,424
|
,000
|
1,527
|
1,313
|
1,777
|
Age 65-74
|
,970
|
,000
|
2,638
|
2,298
|
3,028
|
Age 75+
|
1,940
|
,000
|
6,957
|
6,100
|
7,934
|
Pneumothorax/Hemopneumothorax | ,000 | ||||
Minor Pneumothorax/NFS (AIS 2) | -,332 | ,000 | ,718 | ,596 | ,864 |
Minor Hemopneumothorax (AIS 3) | -,309 | ,000 | ,734 | ,626 | ,861 |
Major Hemothorax or Pneumothorax (AIS 4) | -,050 | ,475 | ,952 | ,830 | 1,090 |
Tension (AIS 5) | ,136 | ,187 | 1,145 | ,936 | 1,401 |
Blood transfusion | ,000 | ||||
1-9 Units
|
,598
|
,000
|
1,819
|
1,628
|
2,033
|
10 + Units
|
1,289
|
,000
|
3,630
|
3,108
|
4,239
|
Initial systolic pressure < 90
|
,695
|
,000
|
2,004
|
1,804
|
2,227
|
Systolic pressure < 90 upon admission
|
1,106
|
,000
|
3,023
|
2,706
|
3,377
|
AIS Head ≥ 3
|
1,367
|
,000
|
3,922
|
3,552
|
4,332
|
AIS Abdomen ≥ 3
|
,314
|
,000
|
1,368
|
1,222
|
1,533
|
Sternal fracture | -,228 | ,008 | ,796 | ,672 | ,943 |
Structural heart injury (AIS ≥ 3)
|
1,502
|
,000
|
4,491
|
2,894
|
6,970
|
Constant | -3,519 | ,000 | ,030 |
Part III: Impact of extrathoracic factors additional to thoracic injuries on ventilator days
Non standardized coefficients | Standardized coefficients | Significance p= | |
---|---|---|---|
(constant) | ≥1,183 | ,000 | |
Age 50–59 years | 1,368 | ,040 | ,000 |
Age 60–69 years | 2,584 | ,066 | ,000 |
Age 70–79 years | 3,746 | ,086 | ,000 |
Age over 80 years | 2,887 | ,047 | ,000 |
Male patient | 1,327 | ,047 | ,000 |
AIS Head ≥ 3 | 5,821 | ,234 | ,000 |
AIS Abdomen ≥ 3 | 1,912 | ,064 | ,000 |
AIS Extremity ≥ 3 | 1,317 | ,052 | ,000 |
Shock (RR ≥90) upon resuscitation | 2,027 | ,063 | ,000 |
Shock (RR ≥90) upon admission | 3,052 | ,079 | ,000 |
Blood transfusion (under 10 units) | 4,458 | ,153 | ,000 |
Blood transfusion (over 10 units) | 5,447 | ,093 | ,000 |
Hemothorax minor (AIS 3) | 1,094 | ,032 | ,000 |
Hemothorax major (AIS 4) | 2,649 | ,069 | ,000 |
Flail chest unilateral minor (AIS 3) | ,823 | ,016 | ,029 |
Flail chest unilateral major (AIS 4) | ,813 | ,015 | ,036 |
Flail chest bilateral (AIS 5) | 3,927 | ,062 | ,000 |
Unilateral minor lung laceration (AIS 3) | 2,525 | ,046 | ,000 |
Unilateral major or bilateral minor lung laceration (AIS 4) | 4,543 | ,086 | ,000 |
Bilateral major lung laceration (AIS 5) | 5,658 | ,034 | ,000 |
Lung contusion unilateral minor (AIS 3) | 1,331 | ,050 | ,000 |
Lung contusion major (AIS 4) | 3,643 | ,072 | ,000 |
Cardiac laceration (AIS ≥ 4) | 8,814 | ,045 | ,000 |
Pneumothorax severe without tension (AIS 4) | 1,089 | ,031 | ,008 |
Tension pneumothorax (AIS 5) | 3,033 | ,050 | ,000 |
Major intrathoracic vessel lesion (AIS 5/6) | 6,231 | ,036 | ,000 |