Prognostic analysis of patients with blunt chest trauma admitted to an intensive care unit

  • Wang S
  • Wei T
  • Chen C
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Abstract

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/F1O2 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 1SS. 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% (p2/F1O2 ratio, 211+/-124 vs. 340+/-145 (p=0.002). Of the shock patients, they had significantly higher volumes of blood transfusions and fluid resuscitations (p2/F1O2 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/F1O2, a lower GCS and a presence of shock were also independent prognostic predictors of mortality for these patients admitted to the ICU. 2007 Elsevier & Formosan Medical Association

Author-supplied keywords

  • *thorax blunt trauma/di [Diagnosis]
  • *thorax blunt trauma/ep [Epidemiology]
  • *thorax blunt trauma/et [Etiology]
  • *thorax blunt trauma/th [Therapy]
  • APACHE
  • China
  • Embase
  • Glasgow coma scale
  • Hong Kong
  • Taiwan
  • Therapeutic Intervention Scoring System
  • abdomen
  • abdominal injury
  • adult
  • age
  • aged
  • analysis
  • article
  • blood
  • blood transfusion
  • clinical evaluation
  • coma
  • confidence interval
  • controlled study
  • education
  • evaluation
  • female
  • fluid resuscitation
  • gender
  • head and neck injury
  • health
  • hematothorax
  • hospital
  • human
  • incidence
  • injury
  • injury scale
  • injury severity
  • intensive care
  • intensive care unit
  • logistic regression analysis
  • major clinical study
  • male
  • medical education
  • mortality
  • multivariate analysis
  • multivariate logistic regression analysis
  • oxygenation
  • patient
  • pelvis injury
  • physiology
  • pneumothorax
  • prognosis
  • regression analysis
  • research
  • resuscitation
  • rib fracture
  • risk
  • risk factor
  • scoring system
  • shock
  • shock/th [Therapy]
  • statistical significance
  • surgery
  • surgical technique
  • survival
  • survivor
  • transfusion
  • univariate analysis

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Authors

  • S.-H. Wang

  • T.-S. Wei

  • C.-P. Chen

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