Jowers Jessica, Van Derveer Kevin, Moore Katherine, Harshaw Nathaniel, Reichert Julie M, Karr Hannah, Khaliq Urhum, Cziperle David J, Perea Lindsey L
Department of Surgery, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131, USA.
Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, 555 N Duke Street, Lancaster, PA 17604, USA.
J Clin Med. 2025 Sep 4;14(17):6253. doi: 10.3390/jcm14176253.
: The incidence of dysrhythmia after blunt thoracic trauma varies in the literature from 8-75%, and the complication rate from these dysrhythmias is not well studied. The aims of this study are to (1) identify the incidence of dysrhythmia following blunt thoracic trauma, (2) identify risk factors associated with developing a dysrhythmia, and (3) identify the incidence of cardiac intervention after developing a dysrhythmia. We hypothesize that blunt thoracic trauma may result in post-injury dysrhythmias. : This is a retrospective review of trauma patients ≥ 18 years with a blunt mechanism of injury at a Level 1 Trauma Center from 1/2010 to 3/2022. Patients were included if they had one of the following: rib fracture, sternal fracture, chest wall contusion, pneumothorax, hemothorax, chest pain, chest wall deformity, or chest wall crepitus. Patients were excluded if they had an Abbreviated Injury Scale Chest = 0 or if they had a pre-existing dysrhythmia. Univariate, multivariate, and multivariable statistical analyses were performed. : In total, 2943 patients met inclusion criteria. In total, 574 (19.5%) developed a dysrhythmia; 100 (17.4%) required a new antiarrhythmic at discharge. Patients who developed a dysrhythmia had a nearly two times greater likelihood of requiring cardiac intervention than those without a dysrhythmia (AOR: 1.79; = 0.004). Additional risk factors for requiring cardiac intervention included Injury Severity Score (ISS) 16-25 and >25 ( < 0.001). : The incidence of dysrhythmia after blunt thoracic injury is 19.5% at our level I trauma center. Based on our study, patients that were older, had an ISS > 25, had a history of previous cardiac disease, or required > 5 units of blood products were at an increased risk of developing a dysrhythmia following trauma. As such, future consideration should be given to extended guidelines in monitoring these vulnerable patients.
钝性胸部创伤后心律失常的发生率在文献中的报道为8% - 75%不等,而且这些心律失常的并发症发生率尚未得到充分研究。本研究的目的是:(1)确定钝性胸部创伤后心律失常的发生率;(2)确定与发生心律失常相关的危险因素;(3)确定发生心律失常后心脏介入治疗的发生率。我们假设钝性胸部创伤可能导致伤后心律失常。
这是一项对2010年1月至2022年3月在一级创伤中心就诊的≥18岁钝性损伤机制的创伤患者的回顾性研究。如果患者有以下情况之一则纳入研究:肋骨骨折、胸骨骨折、胸壁挫伤、气胸、血胸、胸痛、胸壁畸形或胸壁捻发音。如果患者的简明损伤定级(AIS)胸部评分为0或有既往心律失常史,则将其排除。进行了单变量、多变量和多因素统计分析。
共有2943例患者符合纳入标准。共有574例(19.5%)发生了心律失常;100例(17.4%)在出院时需要使用新的抗心律失常药物。发生心律失常的患者比未发生心律失常的患者需要进行心脏介入治疗的可能性几乎高出两倍(调整后比值比:1.79;P = 0.004)。需要进行心脏介入治疗的其他危险因素包括损伤严重度评分(ISS)为16 - 25分和>25分(P < 0.001)。
在我们的一级创伤中心,钝性胸部损伤后心律失常的发生率为19.5%。根据我们的研究,年龄较大、ISS > 25、有既往心脏病史或需要超过5单位血液制品的患者在创伤后发生心律失常的风险增加。因此,未来应考虑制定更广泛的指南来监测这些易患患者。