成人喉外伤的流行病学和管理：国家创伤数据库分析。

Epidemiology and Management of Adult Laryngeal Trauma: An Analysis of the National Trauma Data Bank.

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA,

Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,

出版信息

ORL J Otorhinolaryngol Relat Spec. 2023;85(6):340-347. doi: 10.1159/000534646. Epub 2023 Nov 15.

DOI:10.1159/000534646

PMID:37967547

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10652646/

Abstract

INTRODUCTION

Laryngeal injuries are rare but life-threatening airway emergencies. Increased understanding of the epidemiology of these injuries can inform treatment and improve outcomes. We aimed to characterize the demographics and management of adult laryngeal trauma.

METHODS

The National Trauma Data Bank (NTDB) was queried from 2007 to 2015 for patients ≥18 years old with laryngeal trauma. Patient demographics, injury characteristics, and treatment course were collected. Outcomes were assessed via multivariate logistic regression.

RESULTS

From 7.3 million patients, 6,890 (0.1%) patients with laryngeal trauma were identified. Eighty-five percent of patients were male, and the median age was 40. Of these patients, 343 (5.0%) were dead on arrival and of the remaining patients, 510 (7.8%) of patients were deceased at discharge. Common concomitant injuries included facial fractures (27%), intracranial injuries (21%), and rib and sternum fractures (19%). The most common cause of injury was motor vehicle accident (26%), followed by assault with firearms/explosives (12%) and assault with cutting instruments (8%). Forty-three percent of patients received mechanical ventilation and 15% received surgical repair. After correcting for gender, age, and injury severity, firearm injuries (odds ratio [OR] 3.46, 95% CI: [2.88-4.15]) and cutting/piercing injuries (OR 2.23, 95% CI: [1.89-2.64]) were positively associated with the need for mechanical ventilation. Motor vehicle trauma (OR 0.63, 95% CI: [0.46-0.84]) was negatively associated with surgical repair while striking injuries (OR 1.61, 95% CI: [1.25-2.06]) were positively associated. Lastly, shorter time to tracheostomy was significantly associated with shorter ICU stays (p < 0.0001).

CONCLUSION

This study is the largest epidemiologic study of laryngeal trauma to date and identifies the risk of surgical intervention with firearm and cutting injuries as well as the importance of earlier time to tracheostomy for ICU management.

摘要

简介

喉损伤虽少见，但却是危及生命的气道急症。深入了解此类损伤的流行病学特点有助于指导治疗并改善预后。本研究旨在明确成人喉外伤的临床特征及处理方法。

方法

本研究检索了 2007 年至 2015 年美国国家创伤数据库（NTDB）中年龄≥18 岁、诊断为喉外伤的患者，收集了患者的人口统计学特征、损伤特点及治疗经过等信息，并通过多因素 logistic 回归分析评估了患者的预后。

结果

共纳入 730 万例患者，其中 6890 例（0.1%）诊断为喉外伤。85%的患者为男性，中位年龄为 40 岁。343 例（5.0%）患者在入院时已死亡，其余患者中，510 例（7.8%）在出院时死亡。常见的合并伤包括颜面部骨折（27%）、颅内损伤（21%）、肋骨和胸骨骨折（19%）。最常见的损伤原因是机动车事故（26%），其次是火器/爆炸伤（12%）和锐器伤（8%）。43%的患者需要接受机械通气，15%的患者需要接受手术修复。校正性别、年龄和损伤严重程度后，火器伤（比值比 [OR] 3.46，95%可信区间：[2.88-4.15]）和锐器伤（OR 2.23，95%可信区间：[1.89-2.64]）与机械通气需求呈正相关，机动车事故（OR 0.63，95%可信区间：[0.46-0.84]）与手术修复呈负相关，而击打伤（OR 1.61，95%可信区间：[1.25-2.06]）与机械通气需求呈正相关。此外，气管切开术时间越早，患者 ICU 住院时间越短（p < 0.0001）。