Horst Klemens, Andruszkow Hagen, Weber Christian D, Pishnamaz Miguel, Herren Christian, Zhi Qiao, Knobe Matthias, Lefering Rolf, Hildebrand Frank, Pape Hans-Christoph
Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany.
Harald Tscherne Research Laboratory, RWTH Aachen University, Aachen, Germany.
PLoS One. 2017 Oct 19;12(10):e0186712. doi: 10.1371/journal.pone.0186712. eCollection 2017.
Thoracic trauma remains to be a relevant injury to the polytraumatised patient. However, literature regarding how far changes in clinical guidelines for pre- and in-hospital trauma management and diagnostic procedures affect the outcome of multiple injured patients with severe chest injury during a long-term observation period is sparse.
Multiple traumatised patients (age≥16y) documented in the TraumaRegister DGU® (TR-DGU) from January 1st 2005 to December 31st 2014 with severe chest trauma (AIS≥3) were included in this study. Demographic data, the pattern of injury, injury severity, radiographic emergency procedures, indication for intubation, duration of mechanical ventilation, emergency surgery, occurrence of complications and mortality were evaluated per year and over time.
A total of 16,773 patients were analysed. The use of whole body computer tomography increased (p<0.001), while the incidence of plain x-rays decreased (p<0.001). Furthermore, incidence of AISThorax = 3 graded injuries increased (p<0.001) while AISThorax = 4 decreased (p<0.001). Both, rate of patients being intubated at the time of ICU admission decreased (p<0.001) and the time of mechanical ventilation decreased (p<0.001). Additionally, need for emergency surgery, lung failure, sepsis, and multi organ failure all decreased (p<0.001). However, mortality remained unchanged.
Severity of severe chest trauma and associated complications decreased while diagnostics and treatment improved over time. However, mortality remained unchanged. Our results are in line with those expected in the context of the incidence of CT diagnostics, which has increased parallel to the clinical outcome Thus, our data demonstrate a positive trend in the treatment of patients with severe chest trauma.
胸部创伤仍是多发伤患者的一种相关损伤。然而，关于院前和院内创伤管理及诊断程序的临床指南变化在长期观察期内对严重胸部损伤的多发伤患者结局影响程度的文献却很稀少。
本研究纳入了2005年1月1日至2014年12月31日在创伤注册数据库DGU®（TR-DGU）中记录的年龄≥16岁的多发伤患者，这些患者伴有严重胸部创伤（AIS≥3）。每年及随时间评估人口统计学数据、损伤模式、损伤严重程度、放射学急诊程序、插管指征、机械通气时间、急诊手术、并发症发生率及死亡率。
共分析了16773例患者。全身计算机断层扫描的使用增加（p<0.001），而普通X线的发生率下降（p<0.001）。此外，AIS胸部=3级损伤的发生率增加（p<0.001），而AIS胸部=4级损伤的发生率下降（p<0.001）。入住重症监护病房时插管的患者比例下降（p<0.001），机械通气时间也下降（p<0.001）。此外，急诊手术需求、肺衰竭、脓毒症及多器官衰竭均下降（p<0.001）。然而，死亡率保持不变。
随着时间推移，严重胸部创伤的严重程度及相关并发症下降，而诊断和治疗得到改善。然而，死亡率保持不变。我们的结果与CT诊断发生率背景下预期的结果一致，CT诊断发生率与临床结局平行增加。因此，我们的数据表明严重胸部创伤患者的治疗呈现出积极趋势。
