Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Am J Emerg Med. 2022 Dec;62:1-8. doi: 10.1016/j.ajem.2022.09.031. Epub 2022 Sep 28.
Chest wall instability is a potentially life-threatening condition that should be evaluated at a trauma center. While patients with chest wall instability are sent to different trauma center levels, the impact of this on outcomes has not been evaluated yet. This study examines survival to hospital discharge of patients with chest wall instability treated at different trauma center levels.
This is an observational retrospective cohort study analyzed data from National Trauma Data Bank (NTDB) 2017 dataset. The study sample consisted of adult patients who presented with chest wall instability or deformity and for whom the ED disposition was recorded. Descriptive analysis was carried out. Hospital information, patients' demographic and clinical characteristics, and dispositions were compared based on the main independent variable "trauma designation level. This was followed by LASSO regression to determine the impact of the trauma designation level on patients' survival after controlling for most of the extracted factors from NTDB to conduct this study.
The study sample consisted of 1172 patients sustaining chest wall instability or deformity. Most patients were males (78.2%) and had a median age of 52 years. Most were taken to level I (51.5%) or level II (43.2%) trauma centers. The overall survival to hospital discharge was 78.2%. After adjusting for confounders, no difference in patients' survival was noticed between those taken to level II [OR = 1.000; 95% confidence interval (CI): 0.976-1.025] or III [OR = 1.000; 95% CI: 0.993-1.007] trauma centers and those taken to level I centers.
Survival rates for patients having chest wall instability were similar when transported to level II or level III versus level I centers. This finding can help guide pre-hospital field triage criteria for this specific type of injury and highlights the need for more outcome research in organized trauma systems.
胸壁不稳定是一种潜在危及生命的病症，应在创伤中心进行评估。虽然不稳定的胸壁患者被送往不同级别的创伤中心，但目前尚未评估这对结局的影响。本研究旨在调查不同级别创伤中心治疗胸壁不稳定患者的出院生存率。
这是一项观察性回顾性队列研究，分析了 2017 年国家创伤数据库（NTDB）数据集的数据。研究样本包括因胸壁不稳定或畸形就诊且 ED 处置记录的成年患者。进行描述性分析。根据主要自变量“创伤指定级别”比较医院信息、患者人口统计学和临床特征以及处置情况。然后进行 LASSO 回归，以确定在控制 NTDB 中提取的大多数因素后，创伤指定级别对患者生存的影响，以进行这项研究。
本研究样本包括 1172 例胸壁不稳定或畸形患者。大多数患者为男性（78.2%），中位年龄为 52 岁。大多数患者被送往一级（51.5%）或二级（43.2%）创伤中心。总体出院生存率为 78.2%。调整混杂因素后，送往二级[OR=1.000；95%置信区间（CI）：0.976-1.025]或三级[OR=1.000；95%CI：0.993-1.007]创伤中心的患者与送往一级中心的患者的生存率无差异。
送往二级或三级创伤中心的胸壁不稳定患者的生存率相似。这一发现有助于指导这种特定类型损伤的院前现场分诊标准，并强调需要在有组织的创伤系统中进行更多的结局研究。
