Journal of the Formosan Medical Association
Volume 106, Issue 6 , Pages 444-451, 2007

Prognostic Analysis of Patients with Blunt Chest Trauma Admitted to an Intensive Care Unit

  • Shu-Hui Wang

      Affiliations

    • Critical Care Division, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Shu-Hui Wang, Critical Care Division, Department of Surgery, Changhua Christian Hospital, 135 Nan-Hsiao Street, Changhua 500, Taiwan
    • ,
  • Ta-Sen Wei

      Affiliations

    • Department of Medical Education and Research, Changhua Christian Hospital, Changhua, Taiwan
    • ,
  • Chi-Pei Chen

      Affiliations

    • Critical Care Division, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Received 8 March 2006; received in revised form 12 July 2006; accepted 13 March 2007.

Article Outline

Background/purpose

Predictors of mortality in blunt chest trauma patients have mostly been studied by univariate analysis. This study used multivariate analysis to identify the independent predictors in these patients admitted to a surgical intensive care unit (SICU).

Methods

One hundred and twenty-seven blunt thoracic trauma patients consecutively admitted to a SICU were enrolled and evaluated by quantified injury severity scores including Acute Physiology and Chronic Health Evaluation II (APACHE II), Glasgow Coma Scale (GCS), Therapeutic Intervention Scoring System (TISS) and Injury Severity Score (ISS). Incidence of thoracic and extrathoracic injuries, transfusion and resuscitation volumes, PaO2/FIO2 ratio and the presence of shock were also evaluated.

Results

In the univariate analysis, clinical characteristics of survivors (n = 113) and non-survivors (n = 14) at admission were similar regarding age, gender, incidence of intrathoracic injuries and extrathoracic injuries and ISS. The following variables were higher for non-survivors: APACHE II score, 19 ± 6 vs. 12 ± 6 (p = 0.002); TISS points, 39 ± 13 vs. 29 ± 15 (p = 0.019); the presence of shock, 93% vs. 42% (p < 0.001). Non-survivors also had lower GCS, 8 ± 5 vs.14 ± 3 (p < 0.001), and PaO2/FIO2 ratio, 211 ± 124 vs. 340 ± 145 (p = 0.002). Of the shock patients, they had significantly higher volumes of blood transfusions and fluid resuscitations (p < 0.001) and a higher incidence of abdominal injuries (p = 0.031) and mortality rate (p < 0.001) than non-shock patients. Multivariate logistic regression analysis identified three independent risk factors of mortality: GCS (adjusted odds ratio [OR], 0.76; 95% confidence interval [CI], 0.64-0.89; p = 0.001), PaO2/FIO2 ratio (adjusted OR, 0.75; 95% CI, 0.58-0.98; p = 0.036) and shock (adjusted OR, 3.8; 95% CI, 1.24-11.69; p = 0.020).

Conclusion

Blunt chest trauma was usually associated with injuries of other organ systems, especially of the abdomen and head. Besides a decreased PaO2/FIO2, a lower GCS and a presence of shock were also independent prognostic predictors of mortality for these patients admitted to the ICU.

Key Words:  intensive care unit , mortality , risk factor , shock , thoracic injury

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Lewis FR . Thoracic trauma . Surg Clin North Am . 1982;62:97–104
  2. Dougall AM , Paul ME , Finley RT , et al.   Chest trauma-current morbidity and mortality . Trauma . 1977;17:547–552
  3. Shorr RM , Crittenden M , Indeck M , et al.   Blunt thoracic trauma . Ann Surg . 1987;206:200–205
  4. Gaillard M , Herve C , Mandin L , et al.   Mortality prognostic factors in chest injury . Trauma . 1990;30:93–96
  5. Freedland M , Wilson RF , Bender JS , et al.   The management of flail chest injury: factors affecting outcome . J Trauma . 1990;30:1460–1468
  6. Sariego J , Brown JL , Matsumoto T , et al.   Predictors of pulmonary complications in blunt chest trauma . Int Surg . 1993;78:320–323
  7. Kollmorgen DR , Murray KA , Sullivan JJ , et al.   Predictors of mortality in pulmonary contusion . Am J Surg . 1994;168:659–664
  8. Johnson JA , Cogbill TH , Winga ER . Determinants of outcome after pulmonary contusion . J Trauma . 1986;26:695–698
  9. Clark GC , Schecter WP , Trunkey DD . Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion . J Trauma . 1988;28:298–304
  10. Richardson JD , Adams L , Flint LM . Selective management of flail chest and pulmonary contusion . Ann Surg . 1982;196:481–487
  11. Tyburski JG , Collinge JD , Wilson RF , et al.   Pulmonary contusions: quantifying the lesions on chest X-ray films and the factors affecting prognosis . J Trauma . 1999;46:833–838
  12. Pape HC , Remmers D , Rice J , et al.   Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making . J Trauma . 2000;49:496–504
  13. Knaus WA , Draper EA , Wagner DP , et al.   APACHE II: a severity of disease classification system . Crit Care Med. . 1985;13:818–829
  14. Keene AR , Cullen DJ . Therapeutic intervention scoring system: update 1983 . Crit Care Med. . 1983;11:1–3
  15. Baker SP , O'Neill B , Haddon W , et al.   The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care . J Trauma . 1974;14:187–196
  16. Committee on Injury Scaling  . The Abbreviated Injury Scale 1990 Revision . Des Plaines, Illinois: Association for Advancement of Automotive Medicine; 1990;
  17. Bernard GR , Artigas A , Brigham KL , et al.   Report of the American-European consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes and clinical trial coordination . J Crit Care . 1994;9:72–81
  18. Murray JF , Matthay MA , Luce JM , et al.   An expanded definition of the adult respiratory distress syndrome . Am Rev Respir Dis. . 1988;138:720–723
  19. Wu SI , Yang GY , Chou P , et al.   Analysis of traffic injuries in Taiwan in relation to alcohol use and economic loss . Injury . 1992;22:357–361
  20. Kraus JF , Peek-Asa C , Cryer HG . Incidence, severity, and patterns of intrathoracic and intra-abdominal injuries in motorcycle crashes . J Trauma . 2002;52:548–553
  21. Poole GV , Myers RT . Morbidity and mortality rates in major blunt trauma to the upper chest . Ann Surg . 1981;193:71–75
  22. McGonigal MD , Schwab CW , Kander DR , et al.   Supplemental emergent chest computed tomography in the management of blunt torso trauma . J Trauma . 1990;30:1431–1434

PII: S0929-6646(09)60293-X

doi:10.1016/S0929-6646(09)60293-X

Journal of the Formosan Medical Association
Volume 106, Issue 6 , Pages 444-451, 2007

Article Tools