Factors Associated with ICU Admission following Blunt Chest Trauma.

Andrea Bellone,Francesca Cantaluppi,Paolo Pina,Massimo Guanziroli,Annamaria Bianchi,Massimiliano Etteri,Ilaria Bossi,Giovanni Casazza

doi:10.1155/2016/3257846

Andrea Bellone, Francesca Cantaluppi + Show 6 more

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https://doi.org/10.1155/2016/3257846

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Abstract

Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF) and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1%) were admitted to intensive care unit (ICU) within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p = 0.0018) and the severity of trauma score (p < 0.0002) were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure.

Highlights

Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide [1]
Thirtynine patients were excluded from the study (16 patients were immediately intubated, two patients died in the first three hours, 13 patients were sent to the operating surgery, and 8 patients were admitted to the thoracic unit) (Figure 1)
The blunt chest wall trauma patient who can walk into the ED with no immediate lifethreatening injury will commonly develop complications up to 72 h or more after injury, which may prove lifethreatening [9, 10]

Summary

Introduction

Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide [1]. When the injury is not as severe or associate injuries are not present or are minor, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. The aim of this study was to identify the risk factors for admission to the intensive care unit in non-life-threatening patients with blunt chest trauma admitted to the emergency medicine ward and immediately submitted to a strategy that included positive airway pressure, upright position, and pain-control by pharmacologic therapy. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure

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Conclusion