P-251MANAGEMENT OF THORACIC TRAUMA AND ANALYSIS OF RISK FACTORS FOR OUTCOME

Abstract

Objectives: Thoracic trauma is one of the most common injuries. Its management is very challenging and continues to evolve and improve. The purpose of this study is to analyse its risk factors in a high-volume trauma centre with special attention to the outcome. Methods: Between January 2003 and December 2012, data from all patients were prospectively collected and registered at the German Trauma Registry (GTR) thereafter retrospectively analysed. The type of injury, injury severity score (ISS), abbreviated injury scale (AIS), shock room procedures, operative procedures, complications, the use of organ replacement procedures, time of hospital stay, overall survival were analysed. Patients were divided into two groups: group I included patients between January 2003 and December 2007, and group II patients between January 2008 and December 2012. Results: Six hundred and thirty patients (56%) had thoracic trauma; 540 (48%) had associated extrathoracic injuries. Group I: 285 patients (197 males, mean age 46 years). Group II: 345 (251 males, mean age 49 years). No statistical difference was identified between patients in both groups in terms of gender, type of thoracic injury, or accompanied injuries of other organs. Ninety-day mortality was higher in group I (P = 0.024). Complication rates were higher in group I (P = 0.019). Patients with higher thoracic ISS and AIS showed higher mortality rate (P < 0.0001). Young patients were frequently exposed to severe thoracic injury but had a lower mortality rate (P = 0.014). Patients with severe lung contusions had higher mortality (P < 0.001). 23 (8%) patients had emergency thoracotomy in Group I vs 14 patients (4%) in Group II (P = 0.041). Video-assisted thoracoscopic surgery was performed more frequently in Group II (P < 0.001). Conclusions: Thoracic trauma is often under-calculated. Better survival rates is achievable in specialized centres with a multidisciplinary team approach, in the presence of thoracic surgeons. Severe lung contusion, higher thoracic ISS and AIS, and age are independent prognostic factors affecting outcome.