Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 Milan, Italy.
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033 USA.
World J Emerg Surg. 2017 Apr 27;12:19. doi: 10.1186/s13017-017-0131-8. eCollection 2017.
Traumatic, non-iatrogenic esophageal injuries, despite their rarity, are associated with significant morbidity and mortality. The optimal management of these esophageal perforations remains largely debated. To date, only a few small case series are available with contrasting results. The purpose of this study was to examine a large contemporary experience with traumatic esophageal injury management and to analyze risk factors associated with mortality.
This National Trauma Data Bank (NTDB) database study included patients with non-iatrogenic esophageal injuries. Variables abstracted were demographics, comorbidities, mechanism of injury, Abbreviated Injury Scale (AIS), esophageal Organ Injury Scale (OIS), Injury Severity Score (ISS), level of injury, vital signs, and treatment. Multivariate analysis was used to identify independent predictors for mortality and overall complications.
A total of 944 patients with non-iatrogenic esophageal injury were included in the final analysis. The cervical segment of the esophagus was injured in 331 (35%) patients. The unadjusted 24-h mortality (8.2 vs. 14%, = 0.008), 30-day mortality (4.2 vs. 9.3%, = 0.005), and overall mortality (7.9 vs. 13.5%, = 0.009) were significantly lower in the group of patients with a cervical injury. The overall complication rate was also lower in the cervical group (19.8 vs. 27.1%, = 0.024). Multilogistic regression analysis identified age >50, thoracic injury, high-grade esophageal injury (OIS IV-V), hypotension on admission, and GCS <9 as independent risk factors associated with increased mortality. Treatment within the first 24 h was found to be protective (OR 0.284; 95% CI, 0.148-0.546; < 0.001). Injury to the thoracic esophagus was also an independent risk factor for overall complications (OR 1.637; 95% CI, 1.06-2.53; = 0.026).
Despite improvements in surgical technique and critical care support, the overall mortality for traumatic esophageal injury remains high. The presence of a thoracic esophageal injury and extensive esophageal damage are the major independent risk factors for mortality. Early surgical treatment, within the first 24 h of admission, is associated with improved survival.
iStar, HS-16-00883.
外伤性、非医源性食管损伤虽然罕见，但与显著的发病率和死亡率相关。这些食管穿孔的最佳处理方法仍存在很大争议。迄今为止，仅有少数小的病例系列报告，结果存在差异。本研究的目的是检查大量外伤性食管损伤处理的当代经验，并分析与死亡率相关的危险因素。
本研究是一项国家创伤数据库（NTDB）数据库研究，纳入了非医源性食管损伤患者。提取的变量包括人口统计学、合并症、损伤机制、简明损伤评分（AIS）、食管器官损伤评分（OIS）、损伤严重程度评分（ISS）、损伤水平、生命体征和治疗。多变量分析用于确定死亡率和总体并发症的独立预测因素。
共有 944 例非医源性食管损伤患者纳入最终分析。食管颈段损伤 331 例（35%）。未校正的 24 小时死亡率（8.2% vs. 14%，=0.008）、30 天死亡率（4.2% vs. 9.3%，=0.005）和总死亡率（7.9% vs. 13.5%，=0.009）在颈段损伤组显著降低。颈段损伤组的总体并发症发生率也较低（19.8% vs. 27.1%，=0.024）。多因素逻辑回归分析确定年龄>50 岁、胸部损伤、高等级食管损伤（OIS IV-V）、入院时低血压和 GCS<9 是与死亡率增加相关的独立危险因素。在 24 小时内进行治疗被发现具有保护作用（OR 0.284；95%CI，0.148-0.546；<0.001）。胸段食管损伤也是总体并发症的独立危险因素（OR 1.637；95%CI，1.06-2.53；=0.026）。
尽管外科技术和重症监护支持有所改善，但外伤性食管损伤的总体死亡率仍然很高。胸段食管损伤和广泛的食管损伤是死亡率的主要独立危险因素。入院后 24 小时内早期手术治疗与生存率提高相关。
iStar，HS-16-00883。
