Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Pol Przegl Chir. 2021 Jul 19;94(1):12-19. doi: 10.5604/01.3001.0015.0427.
<b>Introduction:</b> Blunt trauma chest contributes to significant number of trauma admissions globally and is a cause of major morbidity and mortality. Many scoring systems and risk factors have been defined in past for prognosticating blunt trauma chest but, none is considered to be gold standard. </br> <b>Aim:</b> This study was conducted to reassess the significance of available scoring systems and others indicators of severity in prognosticating blunt trauma chest patients. </br> <b>Materials and Methods:</b> In this prospective observational study from November 2016 till March 2018, 50 patients with age more than 12 years with blunt chest trauma who required hospitalization were included. Nine risk factors were assessed namely- age of the patient, duration of presentation after trauma, number of ribs fractured, bilateral thoracic injury, evidence of lung contusion, associated extra thoracic injury, need for mechanical ventilation, Revised trauma Score (RTS) and Modified Early Warning Sign Score (MEWS). Severity of blunt thoracic trauma was assessed on following outcomes-SIRS, ARDS and Death. The inferences were drawn with the use of statistical software package SPSS v22.0. </br> <b>Results:</b> The age of 50 patients included in our study with a range of 15 to 76 years, the median age was 35.5 years. Statistically significant association was observed between occurrence of SIRS and multiple ribs fractured (p-value- 0.049), associated extra-thoracic injury (p-value-0.016) and higher MEWS score (p-value-0.025). ARDS occurrence was statistically significantly associated with all the risk factors except age.Death occurred more in patients with delayed duration of presentation to hospital (p-value <0.001), multiple ribs fractured (p-value-0.001), bilateral thoracic injury(p-value<0.001), associated extra-thoracic injury (p-value-0.004), patients who required ventilatory support (p-value<0.001), low RTS (p-value-0.006) and high MEWS (p-value-0.005) on admission. This association was found statistically significant. </br> <b>Conclusion:</b> High MEWS, associated extra-thoracic injuries and multiple rib fractured can very well predict poor outcome in terms of SIRS, ARDS and death. Aggressive treatment protocols should be established for better outcome in these patients with blunt trauma chest.
钝性胸部创伤导致了全球大量创伤患者入院，是导致严重发病率和死亡率的主要原因之一。过去已经定义了许多评分系统和风险因素来预测钝性胸部创伤，但没有一个被认为是金标准。目的：本研究旨在重新评估现有的评分系统和其他严重程度指标在预测钝性胸部创伤患者中的意义。材料和方法：在这项 2016 年 11 月至 2018 年 3 月期间进行的前瞻性观察研究中，纳入了 50 名年龄在 12 岁以上、因钝性胸部创伤需要住院的患者。评估了 9 个风险因素，分别为患者年龄、创伤后出现的时间、肋骨骨折的数量、双侧胸部损伤、肺挫伤的证据、合并的胸外损伤、机械通气的需要、修订后的创伤评分（RTS）和改良早期预警评分（MEWS）。钝性胸部创伤的严重程度根据以下结果进行评估：SIRS、ARDS 和死亡。使用统计软件包 SPSS v22.0 得出结论。结果：纳入本研究的 50 名患者年龄在 15 岁至 76 岁之间，中位数年龄为 35.5 岁。SIRS 的发生与多发肋骨骨折（p 值-0.049）、合并的胸外损伤（p 值-0.016）和更高的 MEWS 评分（p 值-0.025）之间存在统计学显著关联。ARDS 的发生与除年龄以外的所有风险因素均有统计学显著关联。死亡更多地发生在延迟到医院就诊的患者（p 值<0.001）、多发肋骨骨折（p 值-0.001）、双侧胸部损伤（p 值<0.001）、合并的胸外损伤（p 值-0.004）、需要通气支持的患者（p 值<0.001）、低 RTS（p 值-0.006）和高 MEWS（p 值-0.005）。这种关联具有统计学意义。结论：高 MEWS、合并的胸外损伤和多发肋骨骨折可以很好地预测 SIRS、ARDS 和死亡方面的不良预后。对于钝性胸部创伤患者，应制定积极的治疗方案以获得更好的预后。
