Severe thoracic trauma – still an independent predictor for death in multiple injured patients? - Publikationsserver der Universität Regensburg

URN zum Zitieren dieses Dokuments: urn:nbn:de:bvb:355-epub-366409

Grubmüller, Michael, Kerschbaum, Maximilian, Diepold, Eva, Angerpointner, Katharina, Nerlich, Michael und Ernstberger, Antonio (2018) Severe thoracic trauma – still an independent predictor for death in multiple injured patients? Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 26 (1), S. 1-8.

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Andere URL zum Volltext: http://doi.org/10.1186/s13049-017-0469-7, https://sjtrem.biomedcentral.com/articles/10.1186/s13049-017-0469-7

Zusammenfassung

Zusammenfassung

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.

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Dokumentenart:

Artikel

Datum:

8 Januar 2018

Institutionen:

Medizin > Lehrstuhl für Unfallchirurgie

Projekte:

Open Access Publizieren (DFG)

Identifikationsnummer:

Wert	Typ
10.1186/s13049-017-0469-7	DOI

Stichwörter / Keywords:

Multiple trauma patient, Thoracic trauma, Severely injured patient, TraumaRegister, Polytrauma, Major Trauma

Dewey-Dezimal-Klassifikation:

600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin

Status:

Veröffentlicht

Begutachtet:

Ja, diese Version wurde begutachtet

An der Universität Regensburg entstanden:

Eingebracht am:

29 Jan 2018 16:19

Zuletzt geändert:

29 Jan 2018 16:28

Dokumenten-ID:

36640

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

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