Battle Ceri, Hutchings Hayley, Bouamra Omar, Evans Phillip A
NISCHR Haemostasis Biomedical Research Unit. Morriston Hospital, Swansea, United Kingdom.
College of Medicine, Swansea University, Swansea, United Kingdom.
PLoS One. 2014 Mar 7;9(3):e91284. doi: 10.1371/journal.pone.0091284. eCollection 2014.
The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma.
A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding.
A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%). On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2). As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors.
Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing blunt chest wall trauma.
急诊科钝性胸壁创伤患者因迟发性并发症的发生而导致的管理困难在文献中已得到充分认识。既往研究曾将伤前抗血小板治疗作为创伤性颅脑损伤后不良预后的一个危险因素，但未在钝性胸壁创伤患者队列中进行研究。本研究的目的是调查伤前抗血小板治疗作为钝性胸壁创伤后恢复阶段并发症发生的一个危险因素。
完成了一项回顾性研究，分析了2012年和2013年在威尔士一家大型创伤中心就诊的所有钝性胸壁创伤患者的病历。使用单变量和多变量逻辑回归分析，将伤前血小板治疗作为钝性胸壁创伤后并发症发生的一个危险因素进行研究。分析中纳入了先前确定的危险因素以解决混杂因素的影响。
2012年和2013年共有1303例单纯钝性胸壁创伤患者到莫里森医院急诊科就诊，其中144例（11%）记录有并发症。多变量分析发现，伤前抗血小板治疗是单纯钝性胸壁创伤后并发症发生的一个显著危险因素（比值比：16.9；95%置信区间：8.2 - 35.2）。与既往研究一样，患者年龄、肋骨骨折数量、慢性肺病和伤前抗凝药物使用也被发现是显著的危险因素。
伤前抗血小板治疗正越来越多地被用作多种疾病的一线治疗方法，同时老年人群中的创伤发生率也在上升。管理钝性胸壁创伤的临床医生应将伤前抗血小板治疗视为并发症发生的一个危险因素。
