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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2018

Open Access 01-12-2018 | Original research

Severe thoracic trauma – still an independent predictor for death in multiple injured patients?

Authors: Michael Grubmüller, Maximilian Kerschbaum, Eva Diepold, Katharina Angerpointner, Michael Nerlich, Antonio Ernstberger

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2018

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Abstract

Background

Over the past, the severe thoracic trauma has had decisive influence on the outcome of multiple injured patients. Today, new therapies (e.g. extracorporeal membrane oxygenation (ECMO), protective ventilation methods and new forms of patient positioning) are available and applied regularly. What impact on the patient’s outcome does the thoracic trauma have today?

Methods

Prospective data collection of multiple injured patients in a level-I trauma center was performed between 2008 and 2014. Patients with an ISS ≥16 were included and divided into 2 groups: Severe thoracic trauma (STT: AISThorax ≥ 3) and mild thoracic trauma (MTT: AISThorax < 3). In addition to preclinical and trauma room care, detailed information about clinical course and outcome were assessed.

Results

In total, 529 patients (STT: n = 317; MTT: n = 212) met the in- and exclusion criteria. The mean Injury Severity Score (ISS) was significantly higher in patients of the STT group (STT: 33.5 vs. MTT: 24.7; p < 0.001), while the RISC II Score showed no significant differences (STT: 20.0 vs. MTT: 17.1; p = 0.241). Preclinical data revealed a higher intubation rate, more chest tube insertions and a higher use of catecholamines in the STT group (p < 0.05). Clinically, we found significant differences in the duration of invasive ventilation (STT: 7.3d vs. MTT: 5.4d; p = 0.001) and ICU stay (STT: 12.3d vs. MTT: 9.4d; p < 0.001). While the complication rate was higher for the STT group (sepsis (STT: 11.4% vs. MTT: 5.7%; p = 0.017); lung failure (STT: 23.7% vs. MTT: 12.3%; p = 0,001)), neither the non-adjusted lethality rate (STT: 13.2% vs. MTT: 13.7%; p = 0.493) nor the Standardized Mortality Ratio (SMR) showed significant differences (STT: 0.66 vs. MTT: 0.80; p = 0.397). The multivariate regressive analysis confirmed that severe thoracic trauma is not an independent risk factor for lethality in our patient cohort.

Conclusion

Despite a higher injury severity, the extended need of emergency measures and a higher rate of complications in injured patients with severe blunt thoracic trauma, no influence on lethality can be proved. The reduction of the complication rate should be a goal for the next decades.
Literature
1.
2.
Baker SP, OʼNeill B, Haddon W JR., Long WB. The injury severity score. J Trauma Injury, Infection, Critical Care. 1974;14:187–196.
3.
Timm A, Maegele M, Lefering R, Wendt K, Wyen H, TraumaRegister DGU(®). Pre-hospital rescue times and actions in severe trauma. A comparison between two trauma systems: Germany and the Netherlands. Injury. Elsevier; 2014;45 Suppl 3:S43–52.
4.
Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988;28:298–304.CrossRefPubMed
5.
Regel G, Sturm JA, Friedl HP, Nerlich M, Bosch U, Tscherne H. Significance of lung contusion in mortality following polytrauma. Possibilities for therapeutic influence. Chirurg. 1988;59:771–6.PubMed
6.
Gaillard M, Hervé C, Mandin L, Raynaud P. Mortality prognostic factors in chest injury. J Trauma. 1990;30:93–6.CrossRefPubMed
7.
Spieth PM, Koch T, Gama de Abreu M. Approaches to ventilation in intensive care. Dtsch Arztebl Int. 2014;111:714–20.PubMed
8.
Putensen C, Zech S, Wrigge H, Zinserling JR, Stüber F, von Spiegel T, Mutz N. Long-term effects of spontaneous breathing during Ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med. 2001;164:43–9.CrossRefPubMed
9.
Chiumello D, Coppola S, Froio S, Gregoretti C, Consonni D. Noninvasive ventilation in chest trauma: systematic review and meta-analysis. Intensive Care Med. 2013;39:1171–80.CrossRefPubMed
10.
Arlt M, Philipp A, Voelkel S, Rupprecht L, Mueller T, Hilker M, Graf B, Schmid C. Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock. Resuscitation. 2010;81:804–9.CrossRefPubMed
11.
Bottlang M, Long WB, Phelan D, Fielder D, Madey SM. Surgical stabilization of flail chest injuries with MatrixRIB implants: a prospective observational study. Injury. 2013;44:232–8.CrossRefPubMed
12.
Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159–68.CrossRefPubMed
13.
TraumaRegister DGU®. 20 years TraumaRegister DGU®: Development, aims and structure. Injury; 2014;45 Suppl 3:S6–S13.
14.
States JD. The Abbreviated and the Comprehensive Research Injury Scales. STAPP. 400 Commonwealth Drive, Warrendale, PA, United States: SAE International; 1969. p. 690810.
15.
16.
German trauma society. Whitebook. 2nd revised and updated edition. Recommendations on structure, organization, installations and equipment to promote quality, safety and reliability in the medical care of the severely injured in the Federal Republic of Germany. Georg Thieme Verlag, 2012.
17.
Ruchholtz S, Lewan U, Debus F, Mand C, Siebert H, Kuhne CA. TraumaNetzwerk DGU®: optimizing patient flow and management. Injury. 2014;45(Suppl 3):S89–92.CrossRefPubMed
18.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.CrossRefPubMed
19.
Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma Injury, Infection, Critical Care. 1997;43:922–6.CrossRef
20.
Jennett B, Bond M. Assessment of outcome after severe brain damage. Practical Scale Lancet. 1975;305:480–4.CrossRef
21.
Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B. Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II. Crit Care. 2014;18:476.CrossRefPubMedPubMedCentral
22.
Bayer J, Lefering R, Reinhardt S, Kühle J, Südkamp NP, Hammer T, Traumaregister DGU. Severity-dependent differences in early management of thoracic trauma in severely injured patients - Analysis based on the TraumaRegister DGU®. Scand J Trauma Resusc Emerg Med. 2017;25:10.CrossRefPubMedPubMedCentral
23.
Hill AB, Fleiszer DM, Brown RA. Chest trauma in a Canadian urban setting-implications for trauma research in Canada. J Trauma. 1991;31:971–3.CrossRefPubMed
24.
Kulshrestha P, Munshi I, Wait R. Profile of chest trauma in a level I trauma center. J Trauma. 2004;57:576–81.CrossRefPubMed
25.
Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW, et al. The major trauma outcome study: establishing national norms for trauma care. J Trauma. 1990;30:1356–65.CrossRefPubMed
26.
Kleber C, Lefering R, Kleber AJ, Buschmann CT, Bail HJ, Schaser KD, Haas NP, DGU TraumaRegister. [Rescue time and survival of severely injured patients in Germany]. Unfallchirurg. Springer-Verlag; 2013;116:345–350.
27.
Bardenheuer M, Obertacke U, Waydhas C, Nast-Kolb D, AG Polytrauma der DGU. Epidemiologie des Schwerverletzten. Eine prospektive Erfassung der präklinischen und klinischen Versorgung. Unfallchirurg. Springer-Verlag; 2000;103:355–363.
28.
Andruszkow H, Schweigkofler U, Lefering R, Frey M, Horst K, Pfeifer R, Kurt Beckers S, Pape H-C, Hildebrand F. Impact of Helicopter Emergency Medical Service in Traumatized Patients: Which Patient Benefits Most? Burney RE, editor. PLoS ONE; 2016;11:e0146897.
29.
Huber S, Biberthaler P, Delhey P, Trentzsch H, Winter H, van Griensven M, Lefering R, Huber-Wagner S. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®). Scand J Trauma Resusc Emerg Med. 2014;22:52.CrossRefPubMedPubMedCentral
30.
Trupka A, Nast-Kolb D, Schweiberer L. Blunt chest trauma. Unfallchirurg Springer-Verlag. 1998;101:244–58.
31.
Regel G, Lobenhoffer P, Grotz M, Pape HC, Lehmann U, Tscherne H. Treatment results of patients with multiple trauma. J Trauma Injury, Infection, Critical Care. 1995;38:70–8.CrossRef
32.
Ruchholtz S, Lefering R, Paffrath T, Oestern H-J, Neugebauer E, Nast-Kolb D, Pape HC, Oestern HJ. Reduction in mortality of severely injured patients in Germany. Dtsch Arztebl Int. 2008;105:225–31.PubMedPubMedCentral
33.
Mefire AC, Pagbe JJ, Fokou M, Nguimbous JF, Guifo ML, Bahebeck J. Analysis of epidemiology, lesions, treatment and outcome of 354 consecutive cases of blunt and penetrating trauma to the chest in an African setting. S Afr J Surg. 2010;48:90–3.PubMed
34.
Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop. 2009;33:1425–33.CrossRefPubMedPubMedCentral
35.
Zacher MT, Kanz K-G, Hanschen M, Häberle S, van Griensven M, Lefering R, Bühren V, Biberthaler P, Hubner-Wagner S. Association between volume of severely injured patients and mortality in German trauma hospitals. BJS. 2015;102:1213–9.CrossRef
36.
Dijkink S., Wilden G. van der Krijnen P., Dol L., Rhemrev S., King D., DeMoya M., Velmahos G., Schipper I. Polytrauma patients in the Netherlands and the USA: A bi-institutional comparison of processes and outcomes of care, Injury 2017.
37.
Madershahian N, Wittwer T, Strauch J, Franke UFW, Wippermann J, Kaluza M. Wahlers. T. Application of ECMO in multitrauma patients with ARDS as rescue therapy. J Card Surg. 2007;22:180–4.CrossRefPubMed
38.
Johnson JA, Cogbill TH, Winga ER. Determinants of outcome after pulmonary contusion. J Trauma. 1986;26:695–7.CrossRefPubMed
39.
Huber-Wagner S, Qvick M, Mussack T, Euler E, Kay MV, Mutschler W, Kanz KG, DGU. Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the trauma registry of the German trauma society. Vox sang. 7 ed. Blackwell Publishing Ltd. 2007;92:69–78.
Metadata
Title
Severe thoracic trauma – still an independent predictor for death in multiple injured patients?
Authors
Michael Grubmüller
Maximilian Kerschbaum
Eva Diepold
Katharina Angerpointner
Michael Nerlich
Antonio Ernstberger
Publication date
01-12-2018
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-017-0469-7

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