UNLABELLED: PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma patients died within 24 hours of injury (61.5%). CONCLUSIONS Chest injury, almost always blunt, is often diagnosed in polytrauma patients. A prevalent cause of multiple trauma is a traffic accident. Chest injury most frequently involves pulmonary contusion. Nearly half of chest injuries require surgery, of which 2/3 are urgent procedures. The procedure most frequently performed in polytrauma patients with chest injury is chest drainage and this is also a sufficient procedure in 75% of surgically treated patients. KEY WORDS: polytrauma, chest injury, pulmonary contusion, surgical treatment, chest drainage.
- MeSH
- dopravní nehody mortalita statistika a číselné údaje MeSH
- dospělí MeSH
- hrudní chirurgické výkony metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- polytrauma etiologie mortalita patologie chirurgie MeSH
- poranění hrudníku etiologie mortalita patologie chirurgie MeSH
- retrospektivní studie MeSH
- skóre závažnosti úrazu MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- antibakteriální látky terapeutické užití MeSH
- bronchopneumonie etiologie komplikace patofyziologie MeSH
- finanční podpora výzkumu jako téma MeSH
- lidé MeSH
- mechanické ventilátory škodlivé účinky využití MeSH
- multiorgánové selhání komplikace terapie MeSH
- poranění hrudníku komplikace mortalita terapie MeSH
- respirační insuficience komplikace mortalita terapie MeSH
- sepse komplikace terapie MeSH
- Check Tag
- lidé MeSH
PURPOSE: There has been an ongoing increase in the frequency and severity of blunt chest injuries. Their rather high lethality is caused by the injury alone as well as by the following systemic inflammatory response. The aim of the study is to verify the efficacy of the pharmacological blockade of the systemic inflammatory response syndrome (SIRS) in serious blunt chest injuries, and to identify whether the administration of indomethacin as a cyclooxygenase inhibitor could prevent a multiorgan dysfunction (MODS) and a multiorgan failure (MOF). METHODS: Patients were divided into 4 Groups according to trauma severity--injury severity score (ISS) and into two subgroups--an indomethacin subgroup where patients received indomethacin together with standard therapy, and a non-indomethacin subgroup. RESULTS: Eighty-four patients were included in the study and 33 patients were given indomethacin. In Groups III and IV there was a later increase in inflammatory markers in patients treated with indomethacin. The elevation of inflammatory markers and the period of mechanical ventilation support in patients treated with indomethacin were shorter in Groups II and III. Seven (8.3%) patients died. Six of the seven dead patients were from the non-indomethacin subgroup. MOF was the cause of death in two patients in the non-indomethacin subgroup and in one patient in the indomethacin subgroup. CONCLUSION: The results obtained during the first 20 months of the study imply that a certain number of patients with serious blunt chest trauma could benefit from indomethacin administration.
- MeSH
- analýza přežití MeSH
- dospělí MeSH
- financování organizované MeSH
- hodnocení rizik MeSH
- incidence MeSH
- indomethacin aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- multiorgánové selhání mortalita prevence a kontrola MeSH
- následné studie MeSH
- poranění hrudníku diagnóza farmakoterapie mortalita MeSH
- prospektivní studie MeSH
- referenční hodnoty MeSH
- rozvrh dávkování léků MeSH
- senioři MeSH
- skóre závažnosti úrazu MeSH
- syndrom systémové zánětlivé reakce diagnóza farmakoterapie mortalita MeSH
- tupá poranění diagnóza farmakoterapie mortalita MeSH
- výsledek terapie MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
Autoři srovnávají výskyt, příčiny a závažnost nepenetrujících poranění hrudníku ve dvou tříletých období 1986-1989 a 1996-1999. V rozmezí 10 let se výskyt tupých traumat hrudníku zvýšil téměř o 124 %, věkový průměr poraněných se snížil o pět let a nejčastější příčinou byla dopravní nehoda na silnici. Trauma hrudníku je u více než poloviny poraněných součástí mnohočetného zranění nebo polytraumatu. V období 1996-1999 autoři zaznamenali větší počet závažných nitrohrudních poranění včetně přerušení v. azygos u tří nemocných. Vzhledem k nebezpečí z prodlení je nezbytné, aby tato poranění byla z místa nehody transportována přímo na specializovaná pracoviště.
The authors compare the causes and severity of non-penetrating chest injuries during two three-year periods: 1986-1989 and 1996-1999. Within the 10-year interval the incidence of blunt chest injuries increased by almost 124%, the mean age of the casualties reduce by five years and the most frequent cause were road accidents. Chest injuries are in more than half the casualties part of multiple injuries or polytraumatism. During the period 1996-1999 the authors recorded more serious intrathoracic injuries, incl. severing of the v. azygos in three patients. With regard to the danger associated with delay it is essential that these casualties should be taken from the site of the accident directly to a specialized department.
