Benjamin Elizabeth, Recinos Gustavo, Aiolfi Alberto, Inaba Kenji, Demetriades Demetrios
Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA.
Los Angeles County Medical Center + USC, 2051 Marengo St, Inpatient Tower, C5L-100, Los Angeles, CA, 90033, USA.
World J Surg. 2018 Dec;42(12):3927-3931. doi: 10.1007/s00268-018-4723-6.
Flail chest is considered a highly morbid condition with reported mortality ranging from 10 to 20%. It is often associated with other severe injuries, which may complicate management and interpretation of outcomes. The physiologic impact and prognosis of isolated flail chest injury is poorly defined.
This is a National Trauma Databank study. All patients from 1/2007 to 12/2014 admitted with flail chest were extracted. Patients with head or abdominal AIS ≥3, dead on arrival, or transferred, were excluded. Primary outcome was mortality; secondary outcomes were need for mechanical ventilation and pneumonia.
Of the 1,047,519 patients with blunt chest injury, 14,718 (1.4%) patients presented with flail chest, and 8098 (0.77%) met inclusion criteria. The most commonly associated intrathoracic injuries were hemothorax (57.9%) and lung contusions (63.0%), while sternal fracture (8.8%) and cardiac contusion (2.5%) were less common. In total, 29.8% of patients required mechanical ventilation, and 11.2% developed pneumonia. Overall mortality was 5.6%. On multivariable analysis, age >65 and need for mechanical ventilation were independent risk factors for mortality (OR 6.02, 3.75, respectively, p < 0.001). Independent predictors for mechanical ventilation included cardiac or pulmonary contusion and sternal fractures (OR 3.78, 2.38, 2.29, respectively, p < 0.001). Need for mechanical ventilation was an independent predictor of pneumonia (OR 13.18, p < 0.001).
Mortality in isolated flail chest is much lower than previously reported. Fewer than 30% of patients require mechanical ventilation. Need for mechanical ventilation, however, is independently associated with mortality and pneumonia. Age >65 is an independent risk factor for adverse outcomes, and these patients may benefit by more aggressive monitoring and treatment.
连枷胸被认为是一种高发病症，据报道死亡率在10%至20%之间。它常与其他严重损伤相关，这可能使治疗管理和结果解读变得复杂。孤立性连枷胸损伤的生理影响和预后尚不明确。
这是一项国家创伤数据库研究。提取了2007年1月至2014年12月期间所有因连枷胸入院的患者。排除头部或腹部简明损伤定级（AIS）≥3、入院时已死亡或已转院的患者。主要结局是死亡率；次要结局是机械通气需求和肺炎。
在1,047,519例钝性胸部损伤患者中，14,718例（1.4%）出现连枷胸，8098例（0.77%）符合纳入标准。最常见的相关胸内损伤是血胸（57.9%）和肺挫伤（63.0%），而胸骨骨折（8.8%）和心脏挫伤（2.5%）较少见。总体而言，29.8%的患者需要机械通气，11.2%的患者发生肺炎。总体死亡率为5.6%。多变量分析显示，年龄>65岁和需要机械通气是死亡率的独立危险因素（比值比分别为6.02和3.75，p<0.001）。机械通气的独立预测因素包括心脏或肺挫伤以及胸骨骨折（比值比分别为3.78、2.38、2.29，p<0.001）。需要机械通气是肺炎的独立预测因素（比值比为13.18，p<0.001）。
孤立性连枷胸的死亡率远低于先前报道。不到30%的患者需要机械通气。然而，需要机械通气与死亡率和肺炎独立相关。年龄>65岁是不良结局的独立危险因素，这些患者可能通过更积极的监测和治疗而受益。
