Bilateral thoracic trauma-"double the trouble"?

Abstract

Thoracic trauma is associated with a high morbidity and mortality. Assessing the risk for complications is essential for planning the further treatment strategies and managing resources in thoracic trauma. The aim of the study was to analyze concomitant injuries in unilateral and bilateral rib fractures and pulmonary contusions and evaluate differences in complication rates between the two. In aretrospective study, data from all patients diagnosed with thoracic trauma at alevelI trauma center were analyzed. Bivariate and multivariate analysis were used to examine an association of unilateral or bilateral rib fractures, serial rib fractures, and pulmonary contusions with multiple injuries and outcomes. In addition, multivariate regression analysis was utilized to determine the impact of age, gender and additional injuries on outcome. A total of 714patients were included in the analysis. The mean Injury Severity Score (ISS) was19. Patients with an additional thoracic spine injury had asignificantly higher incidence of bilateral rib fractures. Pulmonary contusions were associated with younger age. Abdominal injuries were predictors for bilateral pulmonary contusions. Complications occurred in 36% of the patients. Bilateral injuries increased the complication rate up to 70%. Pelvic and abdominal injuries as well as the need for achest drain were significant risk factors for complications. The mortality rate was 10%, with higher age, head and pelvic injuries as predictors. Patients with bilateral chest trauma had an increased incidence of complications and ahigher mortality rate. Bilateral injuries and significant risk factors must therefore be considered. Injury of the thoracic spine should be excluded in those patients.