Top

Published in:

Open Access 01-12-2017 | Research article

Thoracic trauma severity contributes to differences in intensive care therapy and mortality of severely injured patients: analysis based on the TraumaRegister DGU®

Authors: Jörg Bayer, Rolf Lefering, Sylvia Reinhardt, Jan Kühle, Jörn Zwingmann, Norbert P. Südkamp, Thorsten Hammer, TraumaRegister DGU

Published in: World Journal of Emergency Surgery | Issue 1/2017

Abstract

Background

Thoracic trauma is a relevant source of comorbidity throughout multiply-injured patient care. We aim to determine a measurable influence of chest trauma’s severity on early resuscitation, intensive care therapy, and mortality in severely injured patients.

Methods

Patients documented between 2002 and 2012 in the TraumaRegister DGU®, aged ≥ 16 years, injury severity score (ISS) ≥ 16 are analyzed. Isolated brain injury and severe head injury led to exclusion. Subgroups are formed using the Abbreviated Injury Scale_Thorax.

Results

Twenty-two thousand five hundred sixty-five patients were predominantly male (74%) with mean age of 45.7 years (SD 19.3), blunt trauma (95%), mean ISS 25.6 (SD 9.6). Overall mean intubation period was 5.6 days (SD 10.7). Surviving patients were discharged from the ICU after a mean of about 5 days following extubation. Thoracic trauma severity (AIS_Thorax ≥ 4) and fractures to the thoracic cage significantly prolonged the ventilation period. Additionally, fractures extended the ICU stay significantly. Suffering from more than one thoracic injury was associated with a mean of 1–2 days longer intubation period and longer ICU stay. Highest rates of sepsis, respiratory, and multiple organ failure occurred in patients with critical compared to lesser thoracic trauma severity.

Conclusion

Thoracic trauma severity in multiply-injured patients has a measurable impact on rates of respiratory and multiple organ failure, sepsis, mortality, time of mechanical ventilation, and ICU stay.

Vecsei V, Arbes S, Aldrian S, Nau T. Chest injuries in polytrauma. Eur J Trauma. 2005;31:239–43.CrossRef

Bardenheuer M, Obertacke U, Waydhas C, Nast-Kolb D. Epidemiology of the severely injured patient. A prospective assessment of preclinical and clinical management. AG Polytrauma of DGU. Unfallchirurg. 2000;103:355–63.CrossRefPubMed

Huang YK, Liu KS, Lu MS, Wu MY, Tsai FC, Lin PJ. Extracorporeal life support in post-traumatic respiratory distress patients. Resuscitation. 2009;80:535–9.CrossRefPubMed

Ruchholtz S, Lefering R, Paffrath T, Oestern HJ, Neugebauer E, Nast-Kolb D, et al. Reduction in mortality of severely injured patients in Germany. Dtsch Arztebl Int. 2008;105:225–31.PubMedPubMedCentral

Bayer J, Lefering R, Reinhardt S, Kühle J, Südkamp NP, Hammer T. Severity-dependent differences in early management of thoracic trauma in severely injured patients—analysis based on the TraumaRegister DGU(R). Scand J Trauma Resusc Emerg Med. 2017;25:10.CrossRefPubMedPubMedCentral

Fröhlich M, Lefering R, Probst C, Paffrath T, Schneider MM, Maegele M, et al. Epidemiology and risk factors of multiple-organ failure after multiple trauma: an analysis of 31,154 patients from the TraumaRegister DGU. J Trauma Acute Care Surg. 2014;76:921–7.CrossRefPubMed

Sauaia A, Moore EE, Johnson JL, Chin TL, Banerjee A, Sperry JL, et al. Temporal trends of postinjury multiple-organ failure: still resource intensive, morbid, and lethal. J Trauma Acute Care Surg. 2014;76:582–92.CrossRefPubMedPubMedCentral

Ried M, Bein T, Philipp A, Muller T, Graf B, Schmid C, et al. Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. Crit Care. 2013;17:R110.CrossRefPubMedPubMedCentral

Gaillard M, Herve C, Mandin L, Raynaud P. Mortality prognostic factors in chest injury. J Trauma. 1990;30:93–6.CrossRefPubMed

10.

Inthorn D, Huf R. Thoracic trauma in multiple trauma. Anasthesiol Intensivmed Notfallmed Schmerzther. 1992;27:498–501.CrossRefPubMed

11.

Brasel KJ, Guse CE, Layde P, Weigelt JA. Rib fractures: relationship with pneumonia and mortality. Crit Care Med. 2006;34:1642–6.CrossRefPubMed

12.

Treggiari MM, Hudson LD, Martin DP, Weiss NS, Caldwell E, Rubenfeld G. Effect of acute lung injury and acute respiratory distress syndrome on outcome in critically ill trauma patients. Crit Care Med. 2004;32:327–31.CrossRefPubMed

13.

Ruchholtz S, Waydhas C, Ose C, Lewan U, Nast-Kolb D. Prehospital intubation in severe thoracic trauma without respiratory insufficiency: a matched-pair analysis based on the Trauma Registry of the German Trauma Society. J Trauma. 2002;52:879–86.PubMed

14.

Gennarelli TA, Wodzin E. AIS 2005. Barrington, IL: Association for the Advancement of Automotive Medicine; 2005.

15.

Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.CrossRefPubMed

16.

Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997;43:922–5.CrossRefPubMed

17.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.CrossRefPubMed

18.

American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864-874.

19.

Geiger EV, Lustenberger T, Wutzler S, Lefering R, Lehnert M, Walcher F, et al. Predictors of pulmonary failure following severe trauma: a trauma registry-based analysis. Scand J Trauma Resusc Emerg Med. 2013;21:34.CrossRefPubMedPubMedCentral

20.

Di Bartolomeo S, Sanson G, Nardi G, Scian F, Michelutto V, Lattuada L. A population-based study on pneumothorax in severely traumatized patients. J Trauma. 2001;51:677–82.CrossRefPubMed

21.

Dai D, Yuan Q, Sun Y, Yuan F, Su Z, Ding J, et al. Impact of thoracic injury on traumatic brain injury outcome. PLoS One. 2013;8:e74204.CrossRefPubMedPubMedCentral

22.

Hildebrand F, Giannoudis PV, Griensven M, Zelle B, Ulmer B, Krettek C, et al. Management of polytraumatized patients with associated blunt chest trauma: a comparison of two European countries. Injury. 2005;36:293–302.CrossRefPubMed

23.

Hildebrand F, van Griensven M, Garapati R, Krettek C, Pape HC. Diagnostics and scoring in blunt chest trauma. Eur J Trauma. 2002;28:157–67.CrossRef

24.

Trupka A, Waydhas C, Nast-Kolb D, Schweiberer L. Early intubation in severely injured patients. Eur J Emerg Med. 1994;1:1–8.CrossRefPubMed

25.

Pressley CM, Fry WR, Philp AS, Berry SD, Smith RS. Predicting outcome of patients with chest wall injury. Am J Surg. 2012;204:910–3.CrossRefPubMed

26.

Becher RD, Colonna AL, Enniss TM, Weaver AA, Crane DK, Martin RS, et al. An innovative approach to predict the development of adult respiratory distress syndrome in patients with blunt trauma. J Trauma Acute Care Surg. 2012;73:1229–35.CrossRefPubMed

27.

Martin M, Salim A, Murray J, Demetriades D, Belzberg H, Rhee P. The decreasing incidence and mortality of acute respiratory distress syndrome after injury: a 5-year observational study. J Trauma. 2005;59:1107–13.CrossRefPubMed

28.

Salim A, Martin M, Constantinou C, Sangthong B, Brown C, Kasotakis G, et al. Acute respiratory distress syndrome in the trauma intensive care unit: morbid but not mortal. Arch Surg. 2006;141:655–8.CrossRefPubMed

29.

Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2:319–23.CrossRefPubMed

30.

Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342:1334–49.CrossRefPubMed

31.

Minei JP, Cuschieri J, Sperry J, Moore EE, West MA, Harbrecht BG, et al. The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock. Crit Care Med. 2012;40:1129–35.CrossRefPubMedPubMedCentral

32.

Laudi S, Donaubauer B, Busch T, Kerner T, Bercker S, Bail H, et al. Low incidence of multiple organ failure after major trauma. Injury. 2007;38:1052–8.CrossRefPubMed

33.

Pfeifer R, Tarkin IS, Rocos B, Pape HC. Patterns of mortality and causes of death in polytrauma patients—has anything changed? Injury. 2009;40:907–11.CrossRefPubMed

34.

Hussmann B, Lendemans S. Pre-hospital and early in-hospital management of severe injuries: changes and trends. Injury. 2014;45:S39–42.CrossRefPubMed

35.

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

36.

Lefering R, Paffrath T. Reality of care based on the data from the Trauma Registry of the German Society of Trauma Surgery. Unfallchirurg. 2012;115:30–2.CrossRefPubMed

Title: Thoracic trauma severity contributes to differences in intensive care therapy and mortality of severely injured patients: analysis based on the TraumaRegister DGU®
Authors: Jörg Bayer
Rolf Lefering
Sylvia Reinhardt
Jan Kühle
Jörn Zwingmann
Norbert P. Südkamp
Thorsten Hammer
TraumaRegister DGU
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: World Journal of Emergency Surgery / Issue 1/2017
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-017-0154-1

At a glance: The STEP trials

Springer Medicine

Thoracic trauma severity contributes to differences in intensive care therapy and mortality of severely injured patients: analysis based on the TraumaRegister DGU®

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship—results from an international cross-sectional survey

2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias

Erratum to: Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review

Lower gastrointestinal bleeding—Computed Tomographic Angiography, Colonoscopy or both?