The incidence,clinical characteristics,and outcome of polytrauma patients with the combination of pulmonary contusion,flail chest and upper thoracic spinal injury |
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| Institution: | 1. Division of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology;2. Department of Immunology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;3. Class 1901, School of medicine, Wuhan University of Science and Technology, Wuhan 430065, China;1. Penn State College of Medicine, Hershey, PA, 17033 USA;2. Department of Orthopaedics and Rehabilitation, Penn State Hershey Medical Center, Hershey, PA, 17033 USA;3. Public Health Sciences, Penn State College of Medicine, Hershey, PA, 17033 USA;4. Department of Anesthesiology, University of Utah, Salt Lake City, UT, 84132 USA;1. Computational Neurosciences Outcomes Center, Department of Neurosurgery, Harvard Medical School, Brigham and Women''s Hospital, Boston, MA, USA;2. Channing Division of Network Medicine, Department of Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA, USA;1. Servicio de Medicina Intensiva, Spain;2. Hospital Universitario 12 de Octubre, Madrid, Spain;3. Trinity College Dublin, School of Medicine. CLOD Dublin Midlands Hospital group, Dublin, EIRE;4. Intensive Care Medicine, Spain;5. Biochemistry Department, Spain;1. Department of Obstetrics and Gynecology, Kitasato University Medical Center, Arai 6-100, Kitamoto-shi, Saitama 364-8501, Japan;2. Scientifics Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan;3. Department of Psychiatry, Seichiryo Hospital, Tsurumai 4-16-27, Showa-ku, Nagoya 466-0064, Japan;4. Department of Psychiatry, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya 466-8560 Japan;5. Department of General Medicine, Taragi Municipal Hospital, 4210 Taragi, Taragi-machi, Kuma-gun, Kumamoto 868-0598, Japan;6. Department of Health Research Methods, Evidence & Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada;7. Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11 Kaga, Itabashi-ku, Tokyo 174-0054, Japan;1. Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom;2. Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom;3. Higher Orthopaedic Trainee, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom;4. Consultant Paediatric Orthopaedic Surgeon, Department of Paediatric Orthopaedics, Paediatric Division, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom;1. Kartal Dr. Lutfi Kirdar Training and Research Hospital, Department of Orthopedics and Trauma Surgery, Turkey;2. Yeditepe University Hospital, Department of Physical Medicine and Rehabilitation, Turkey |
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| Abstract: | BackgroundChest trauma was the third most common cause of death in polytrauma patients, accounting for 25% of all deaths from traumatic injury. Chest trauma involves in injury to the bony thorax, intrathoracic organs and thoracic medulla. This study aimed to investigate the incidence, clinical characteristics, and outcome of polytrauma patients with pulmonary contusion, flail chest and upper thoracic spinal injury.MethodsPatients who met inclusion criteria were divided into groups: Pulmonary contusion group (PC); Pulmonary contusion and flail chest group (PC + FC); Pulmonary contusion and upper thoracic spinal cord injury group (PC + UTSCI); Thoracic trauma triad group (TTT): included patients with flail chest, pulmonary contusion and the upper thoracic spinal cord injury coexisted. Outcomes were determined, including 30-day mortality and 6-month mortality.ResultsA total 84 patients (2.0%) with TTT out of 4176 polytrauma patients presented to Tongji trauma center. There was no difference in mean ISS among PC + FC group, PC + UTSCI group and TTT group. Patients with TTT had a longer ICU stay (21.4 days vs. 7.5 and 6.2; p<0.01), relatively higher 30-day mortality (40.5% vs. 6.0% and 4.3%; p<0.01), and especially higher 6-month mortality (71.4% vs. 6.5%, 13.0%; p<0.01), compared to patients with PC + FC or with PC + UTSCI. The leading causes of death for patients with TTT were ARDS (44.1%) and pulmonary infection (26.5%) during first 30 days after admission. For those patients who died later than 30 days during the 6 months, the predominant underlying cause of death was MOF (53.8%).ConclusionsLethal triad of thoracic trauma (LTTT) were described in this study, which consisting of pulmonary contusion,flail chest and the upper thoracic spine cord injury. Like the classic “lethal triad”, there was a synergy between the factors when they coexist, resulting in especially high mortality rates. Polytrauma patients with LTTT were presented relatively high 30-day mortality and 6 months mortality. We should pay much more attention to the patients with LTTT for further minimizing complications and mortality. |
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