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Ulusal Travma Ve Acil Cerrahi Dergisi =... Jul 2021Traumatic chylothorax is a rare condition following blunt trauma. Although a chyle leak resulting from direct damage to the duct may occur at any level because of an...
Traumatic chylothorax is a rare condition following blunt trauma. Although a chyle leak resulting from direct damage to the duct may occur at any level because of an anatomical variation, an airway obstruction due to thoracic duct injury after blunt trauma has never been described. Here, we report a very unusual case with airway obstruction due to thoracic duct injury after whiplash injury. A 60-year-old man presented to the emergency department with allodynia after blunt trauma. Initial chest computed tomography (CT) showed a prevertebral hematoma and pneumomediastinum from C2 to T3 spinal level without vertebral fracture. Seven days later, repeat CT showed an increased amount of mediastinal and prevertebral fluid collection extending to the upper neck level with airway compression. He underwent an operation to drain the fluid via a neck incision and a thoracic duct ligation via right thoracotomy and was discharged without complaint. The findings suggest that if hematoma and pneumomediastinum are found in the prevertebral space at the level of the cervical and upper thoracic spine, the patient should be closely observed to exclude the complication of airway obstruction caused by thoracic duct injury.
Topics: Airway Obstruction; Chylothorax; Humans; Male; Middle Aged; Thoracic Duct; Thoracic Injuries; Whiplash Injuries
PubMed: 34212992
DOI: 10.14744/tjtes.2020.08055 -
Polski Przeglad Chirurgiczny Jul 2021<b>Introduction:</b> Blunt trauma chest contributes to significant number of trauma admissions globally and is a cause of major morbidity and mortality. Many... (Observational Study)
Observational Study
<b>Introduction:</b> Blunt trauma chest contributes to significant number of trauma admissions globally and is a cause of major morbidity and mortality. Many scoring systems and risk factors have been defined in past for prognosticating blunt trauma chest but, none is considered to be gold standard. </br> <b>Aim:</b> This study was conducted to reassess the significance of available scoring systems and others indicators of severity in prognosticating blunt trauma chest patients. </br> <b>Materials and Methods:</b> In this prospective observational study from November 2016 till March 2018, 50 patients with age more than 12 years with blunt chest trauma who required hospitalization were included. Nine risk factors were assessed namely- age of the patient, duration of presentation after trauma, number of ribs fractured, bilateral thoracic injury, evidence of lung contusion, associated extra thoracic injury, need for mechanical ventilation, Revised trauma Score (RTS) and Modified Early Warning Sign Score (MEWS). Severity of blunt thoracic trauma was assessed on following outcomes-SIRS, ARDS and Death. The inferences were drawn with the use of statistical software package SPSS v22.0. </br> <b>Results:</b> The age of 50 patients included in our study with a range of 15 to 76 years, the median age was 35.5 years. Statistically significant association was observed between occurrence of SIRS and multiple ribs fractured (p-value- 0.049), associated extra-thoracic injury (p-value-0.016) and higher MEWS score (p-value-0.025). ARDS occurrence was statistically significantly associated with all the risk factors except age.Death occurred more in patients with delayed duration of presentation to hospital (p-value <0.001), multiple ribs fractured (p-value-0.001), bilateral thoracic injury(p-value<0.001), associated extra-thoracic injury (p-value-0.004), patients who required ventilatory support (p-value<0.001), low RTS (p-value-0.006) and high MEWS (p-value-0.005) on admission. This association was found statistically significant. </br> <b>Conclusion:</b> High MEWS, associated extra-thoracic injuries and multiple rib fractured can very well predict poor outcome in terms of SIRS, ARDS and death. Aggressive treatment protocols should be established for better outcome in these patients with blunt trauma chest.
Topics: Adolescent; Adult; Aged; Child; Humans; Injury Severity Score; Lung Injury; Middle Aged; Prospective Studies; Retrospective Studies; Risk Factors; Thoracic Injuries; Wounds, Nonpenetrating; Young Adult
PubMed: 35195077
DOI: 10.5604/01.3001.0015.0427 -
The Journal of Thoracic and... Dec 2014
Topics: Aorta, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Thoracic Injuries; Vascular System Injuries; Wounds, Nonpenetrating
PubMed: 25451507
DOI: 10.1016/j.jtcvs.2014.09.114 -
Journal of Cardiothoracic Surgery Aug 2021Road traffic crashes related (RTCR) chest traumas remain important global public health challenge. The impact of boosting market of automobile vehicles in China during...
BACKGROUND
Road traffic crashes related (RTCR) chest traumas remain important global public health challenge. The impact of boosting market of automobile vehicles in China during last decade on thoracic injury needs to be defined. This study aimed to review and analyze the demographic and clinical characteristics of RTCR thoracic injuries in China.
METHODS
Clinical records of patients with thoracic trauma admitted to thoracic surgery department between January 2003 and June 2020 were retrospectively retrieved and reviewed. Patients' profiles and clinical characteristics were comparatively analyzed between road traffic crashes caused injury and other injury mechanisms, and in RTCR chest trauma patients before January 2011 (2003 group), and after January 2011 (2011 group), when is considered as the beginning year of Chinese household vehicle era.
RESULTS
The study included 5095 thoracic trauma patients with mean age of 50.2 years, of whom 79.4% were male. Most of the patients (70.3%, n = 3583) had rib fractures. Associated injuries were present in 52.0% of the patients, of them 78.5% (n = 2080) were extremity fractures. Road traffic crashes accounted for 41.4% (n = 2108) of the injuries, most of them (98.0%) were related to motor vehicles. In comparison with other chest trauma mechanisms, RTCR chest injuries affected females and older males more frequently, with a higher incidence of rib fractures and sternum fractures, and higher injury severity scores (ISS) (all p < 0.05). Surgeries were required in 1495 (70.9%) patients of the RRTCR chest traumas, while the majority of non-RTCR thoracic injuries were managed conservatively or with tube thoracostomy (30.2%, n = 901). RTCR chest traumas caused longer hospital stay (13.0 ± 9.6 days vs. 11.8 ± 7.4 days, p = 0.001), higher ICU usage (30.7% vs. 19.6%, p = 0.001), higher rate of ventilator support (12.9% vs. 7.5%, p = 0.001), and higher mortalities (3.8% vs. 1.6%, p = 0.005) than that of non-RTRA chest injuries. For RTCR patients, when compared with 2003 group, 2011 group had similar patterns in terms of accident category, associated injury and treatment. However, 2011 group had more females (38.5% vs. 18.0%, p = 0.001) and older males (50.6 ± 9.7 vs. 47.9 ± 17.2, p = 0.001), with a higher ISS (18.3 ± 10.2 vs. 17.1 ± 8.9, p = 0.004), and fewer were managed with chest tubes (25.0% vs. 29.2%, p = 0.031). Clinical outcomes were not significantly different between the groups in terms of hospital length of stay, intensive care unit (ICU) usage, ICU length of stay, duration of ventilator hours and mortality. However, the 2011 group had more patients requiring ventilator support (14.4% vs. 10.6%, p = 0.011).
CONCLUSIONS
Road traffic crashes remain to be the major etiology of thoracic injuries in China, which usually affects middle-aged males, causing rib fractures with concomitant injuries frequently occurring to other organ systems. Treatments mainly include tube thoracotomy and surgical procedures. Although the clinical characteristics and outcomes of traffic accident related chest traumas are largely unchanged in spite of the rapid increasing numbers of motor vehicles, variations in the pattern of injuries by gender, age, injury severity and ventilator usage may still provide important information for targeted management.
Topics: Accidents, Traffic; Adult; Female; Humans; Injury Severity Score; Male; Middle Aged; Retrospective Studies; Rib Fractures; Thoracic Injuries
PubMed: 34348741
DOI: 10.1186/s13019-021-01599-4 -
JAMA Network Open Feb 2019Thoracic endovascular aortic repair (TEVAR) has been adopted rapidly for treating traumatic thoracic aortic injury (TAI). The long-term durability and efficacy remain...
IMPORTANCE
Thoracic endovascular aortic repair (TEVAR) has been adopted rapidly for treating traumatic thoracic aortic injury (TAI). The long-term durability and efficacy remain unknown.
OBJECTIVE
To determine the long-term outcomes of thoracic endovascular aortic repair and those of open repair (OR) for traumatic TAI.
DESIGN, SETTING, PARTICIPANTS
This nationwide cohort study used Taiwan's National Health Insurance Database to evaluate patients with traumatic TAI between January 1, 2004, and December 31, 2013. This single-payer National Health Insurance program covered more than 99.9% of the Taiwanese population. Those who received OR or TEVAR for TAI by propensity score matching were included. Data analysis was conducted in October 2017.
EXPOSURES
Thoracic endovascular aortic repair vs open repair.
MAIN OUTCOMES AND MEASURES
In-hospital outcomes, all-cause mortality, aorta reintervention, and stroke during follow-up.
RESULTS
Of the 287 patients (mean [SD] age, 41.66 [17.98] years; 80.5% male) who received OR or TEVAR for TAI, propensity score matching yielded 100 patients each in the OR and TEVAR groups. After propensity score matching, in-hospital mortality risk was significantly lower in the TEVAR group (9 [9.0%]) than in the OR group (27 [27.0%]; TEVAR vs open repair: odds ratio, 0.27; 95% CI, 0.12-0.60). With a mean (SD) follow-up of 2.80 (2.63) years, the proportion of survivors was 71.9% at 1 year, 70.8% at 2 years, 68.2% at 3 years, and 65.1% at 5 years in the OR group vs 88.9% at 1 year, 88.9% at 2 years, 88.9% at 3 years, and 88.9% at 5 years in the TEVAR group (log-rank test, P < .001). The TEVAR group had only 2 events (2%) of late reintervention and 1 event (1%) of late cerebrovascular accident. The proportion of freedom from reintervention was 100% at 1 year, 100% at 2 years, 100% at 3 years, and 100% at 5 years in the OR group vs 97.4% at 1 year, 97.4% at 2 years, 97.4% at 3 years, and 97.4% at 5 years in the TEVAR group (log-rank test, P = .18).
CONCLUSION AND RELEVANCE
Compared with OR, TEVAR was associated with better long-term outcomes, mainly owing to lower mortality during the perioperative period. In addition, TEVAR was associated with a similar rate of survival and reintervention after hospital discharge.
Topics: Adult; Aorta, Thoracic; Endovascular Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Taiwan; Thoracic Injuries; Treatment Outcome; Young Adult
PubMed: 30735232
DOI: 10.1001/jamanetworkopen.2018.7861 -
Journal of Orthopaedic Surgery and... Feb 2019Singular traumatic insults, such as bone fracture, typically initiate an appropriate immune response necessary to restore the host to pre-insult homeostasis with limited...
BACKGROUND
Singular traumatic insults, such as bone fracture, typically initiate an appropriate immune response necessary to restore the host to pre-insult homeostasis with limited damage to self. However, multiple concurrent insults, such as a combination of fracture, blunt force trauma, and burns (polytrauma), are clinically perceived to result in abnormal immune response leading to inadequate healing and resolution. To investigate this phenomenon, we created a model rat model of polytrauma.
METHODS
To investigate relationship between polytrauma and delayed healing, we created a novel model of polytrauma in a rat which encompassed a 3-mm osteotomy, blunt chest trauma, and full-thickness scald burn. Healing outcomes were determined at 5 weeks where the degree of bone formation at the osteotomy site of polytrauma animals was compared to osteotomy only animals (OST).
RESULTS
We observed significant differences in the bone volume fraction between polytrauma and OST animals indicating that polytrauma negatively effects wound healing. Polytrauma animals also displayed a significant decrease in their ability to return to pre-injury weight compared to osteotomy animals. Polytrauma animals also exhibited significantly altered gene expression in osteogenic pathways as well as the innate and adaptive immune response. Perturbed inflammation was observed in the polytrauma group compared to the osteotomy group as evidenced by significantly altered white blood cell (WBC) profiles and significantly elevated plasma high-mobility group box 1 protein (HMGB1) at 6 and 24 h post-trauma. Conversely, polytrauma animals exhibited significantly lower concentrations of plasma TNF-alpha (TNF-α) and interleukin 6 (IL-6) at 72 h post-injury compared to OST.
CONCLUSIONS
Following polytrauma with burn injury, the local and systemic immune response is divergent from the immune response following a less severe singular injury (osteotomy). This altered immune response that follows was associated with a reduced capacity for wound healing.
Topics: Animals; Burns; Disease Models, Animal; Fracture Healing; Inflammation; Kinetics; Leukocytes; Male; Multiple Trauma; Rats; Rats, Sprague-Dawley; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 30782193
DOI: 10.1186/s13018-019-1082-4 -
Journal of Feline Medicine and Surgery Feb 2024The aim of the study was to describe clinical examination and thoracic CT (TCT) findings in cats after trauma, and to identify physical examination findings associated...
OBJECTIVES
The aim of the study was to describe clinical examination and thoracic CT (TCT) findings in cats after trauma, and to identify physical examination findings associated with both abnormalities on TCT and the need for therapeutic interventions.
METHODS
A multicentre, retrospective, observational study was conducted. Cats admitted to the participating hospitals with a history of blunt trauma and that underwent TCT were eligible. Data were collected on signalment, history, physical examination, TCT findings and subsequent interventions.
RESULTS
In total, 137 cats were included. Road traffic accidents (RTAs) were the most frequently reported cause of trauma (69%). Tachypnoea (32%), pale mucous membranes (22%) and dyspnoea (20%) were the most common abnormal findings on thoracic examination. The most frequently identified thoracic pathologies on TCT were atelectasis (34%), pulmonary contusions (33%), pneumothorax (29%) and pleural effusion (20%). Thoracocentesis was the most commonly performed intervention (12%), followed by chest drain placement (7%). A total of 45 (33%) cats had no physical examination abnormalities but did have abnormalities detected on TCT; six of these cats required interventions. Increasing numbers of thoracic abnormalities on clinical examination were associated with increasing likelihood of having abnormal findings on TCT (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.21-3.44, = 0.008) and of requiring an intervention (OR 1.82, 95% CI 1.32-2.51, <0.001).
CONCLUSIONS AND RELEVANCE
RTAs were the most common reported cause of blunt trauma. Atelectasis, pulmonary contusions and pneumothorax were the most common abnormalities identified on TCT, and thoracic drainage was the most utilised intervention. TCT may be useful in identifying cats with normal thoracic physical examination findings that have significant thoracic pathology, and a high number of abnormal findings on thoracic examination should raise suspicion for both minor and major thoracic pathology. The results of this study can be used to assist in selecting appropriate cases for TCT after blunt trauma.
Topics: Cats; Animals; Pneumothorax; Retrospective Studies; Tomography, X-Ray Computed; Thoracic Injuries; Lung Injury; Wounds, Nonpenetrating; Contusions; Physical Examination; Hospitals; United Kingdom; Radiography, Thoracic; Cat Diseases
PubMed: 38415622
DOI: 10.1177/1098612X241228050 -
Injury May 2016Although pulmonary contusion (PC) is traditionally considered a major injury requiring intensive monitoring, more frequent detection by chest CT in blunt trauma... (Observational Study)
Observational Study
BACKGROUND
Although pulmonary contusion (PC) is traditionally considered a major injury requiring intensive monitoring, more frequent detection by chest CT in blunt trauma evaluation may diagnose clinically irrelevant PC.
OBJECTIVES
We sought to determine (1) the frequency of PC diagnosis by chest CT versus chest X-ray (CXR), (2) the frequency of PC-associated thoracic injuries, and (3) PC patient clinical outcomes (mortality, length of stay [LOS], and need for mechanical ventilation), considering patients with PC seen on chest CT only (SOCTO) and isolated PC (PC without other thoracic injury).
METHODS
Focusing primarily on patients who had both CXR and chest CT, we conducted a pre-planned analysis of two prospectively enrolled cohorts with the following inclusion criteria: age >14 years, blunt trauma within 24h of emergency department presentation, and receiving CXR or chest CT during trauma evaluation. We defined PC and other thoracic injuries according to CT reports and followed patients through their hospital course to determine clinical outcomes.
RESULTS
Of 21,382 enrolled subjects, 8661 (40.5%) had both CXR and chest CT and 1012 (11.7%) of these had PC, making it the second most common injury after rib fracture. PC was SOCTO in 739 (73.0%). Most (73.5%) PC patients had other thoracic injury. PC patients had higher admission rates (91.9% versus 61.7%; mean difference 30.2%; 95% confidence interval [CI] 28.1-32.1%) and mortality (4.7% versus 2.0%: mean difference 2.8%; 95% CI 1.6-4.3%) than non-PC patients, but mortality was restricted to patients with other injuries (injury severity scores>10). Patients with PC SOCTO had low rates of associated mechanical ventilation (4.6%) and patients with isolated PC SOCTO had low mortality (2.6%), comparable to that of patients without PC.
CONCLUSIONS
PC is commonly diagnosed under current blunt trauma imaging protocols and most PC are SOCTO with other thoracic injury. Given that they are associated with low mortality and uncommon need for mechanical ventilation, isolated PC and PC SOCTO may be of limited clinical significance.
Topics: Adult; Contusions; Female; Humans; Injury Severity Score; Length of Stay; Lung Injury; Male; Middle Aged; Observational Studies as Topic; Prospective Studies; Radiography, Thoracic; Sensitivity and Specificity; Thoracic Injuries; Tomography, X-Ray Computed; Trauma Centers; United States; Wounds, Nonpenetrating
PubMed: 26708426
DOI: 10.1016/j.injury.2015.11.043 -
Traffic Injury Prevention Feb 2018To develop a disability metric for motor vehicle crash (MVC) thoracic injuries and compare functional outcomes between pediatric and adult populations.
OBJECTIVE
To develop a disability metric for motor vehicle crash (MVC) thoracic injuries and compare functional outcomes between pediatric and adult populations.
METHODS
Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank (NTDB) for the top 95% most frequently occurring AIS 2, 3, 4, and 5 thoracic injuries in NASS-CDS 2000-2011. The NTDB contains a truncated form of the FIM score, including three items (self-feed, locomotion, and verbal expression), each graded from full functional dependence to full functional independence. Pediatric (ages 7-18 years), adult (19-45), middle-aged adult (46-65), and older adult (66+) MVC occupants were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each injury within each age group by dividing the number of patients who were disabled that sustained the specific injury by the number of patients who sustained the specific injury. To account for the impact of more severe co-injuries, a maximum Abbreviated Injury Scale (MAIS) adjusted DR (DR) was also calculated. DR and DR could range from 0 (0% disability risk) to 1 (100% disability risk).
RESULTS
The mean DR for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DR values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, rib fracture, and sternum fracture compared to the other age groups. The pediatric population possessed a higher DR value for flail chest compared to the other age groups.
CONCLUSIONS
Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can impact future age-specific modifications to AIS.
Topics: Abbreviated Injury Scale; Accidents, Traffic; Adolescent; Adult; Age Distribution; Aged; Child; Disabled Persons; Humans; Middle Aged; Risk; Thoracic Injuries
PubMed: 29584488
DOI: 10.1080/15389588.2018.1426927 -
Injury Aug 2020Blunt thoracic injury is present in around 15% of all major trauma presentations. To ensure a standardised approach to the management of physical injury, patient... (Review)
Review
How does the implementation of a patient pathway-based intervention in the acute care of blunt thoracic injury impact on patient outcomes? A systematic review of the literature.
BACKGROUND
Blunt thoracic injury is present in around 15% of all major trauma presentations. To ensure a standardised approach to the management of physical injury, patient pathway-based interventions have been established in many healthcare settings. It currently remains unclear how these complex interventions are implemented and evaluated in the literature. This systematic review aims to identify pathway effectiveness literature and implementation studies in relation to patient pathway-based interventions in blunt thoracic injury care.
METHODS
The databases Medline, Embase, Web of Science, CINAHL, WHO Clinical Trials Register and both the GreyLit & OpenGrey databases were searched without restrictions on date or study type. A search strategy was developed including keywords and MeSH terms relating to blunt thoracic injury, patient pathway-based interventions, evaluation and implementation. Due to heterogeneity of intervention pathways, meta-analysis was not possible; analysis was undertaken using an iterative narrative approach.
RESULTS
A total of 16 studies met the inclusion criteria and were included in analysis. Pathways were identified covering analgesic management, respiratory care, surgical decision making and reducing risk of complications. Studies evaluating pathways are generally limited by their observational and retrospective design, but results highlight the potential benefits of pathway driven care provision in blunt thoracic injury.
CONCLUSIONS
The results demonstrate the complexity of evaluating patient pathway-based interventions in blunt thoracic injury management. It is important that pathways undergo rigorous evaluation, refinement and validation to ensure quality and patient safety. Strong recommendations are precluded as the quality of the pathway evaluation studies are low.
Topics: Critical Care; Delivery of Health Care; Humans; Retrospective Studies; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 32576379
DOI: 10.1016/j.injury.2020.06.002