The Effect of Pre-Injury Anti-Platelet Therapy on the Development of Complications in Isolated Blunt Chest Wall Trauma: A Retrospective Study

Ceri Battle,Hayley Hutchings,Phillip A Evans,Omar Bouamra

doi:10.1371/journal.pone.0091284

Abstract

IntroductionThe difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma.MethodsA retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding.ResultsA total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%). On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2–35.2). As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors.ConclusionsPre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing blunt chest wall trauma.

Highlights

The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature
[6] The difficulties in the management of the blunt chest wall trauma patient are becoming increasingly well recognised in the literature. [7,8] The blunt chest wall trauma patient commonly presents to the Emergency Department (ED) initially with no respiratory difficulties, but can develop respiratory complications approximately 48 to 72 hours later. [9,10] Clinical symptoms are not considered an accurate predictor of outcome following non-life threatening blunt chest wall trauma
[11] A number of welldocumented risk factors for morbidity and mortality exist for blunt chest wall trauma including patient age, pre-existing disease, number of ribs fractured, pre-injury anticoagulant use and the onset of pneumonia during the recovery phase. [12,13]The aim of this study was to investigate whether the use of pre-injury anti-platelets is a risk factor for the development of complications in blunt chest wall trauma patients

Summary

Introduction

Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma. [11] A number of welldocumented risk factors for morbidity and mortality exist for blunt chest wall trauma including patient age, pre-existing disease, number of ribs fractured, pre-injury anticoagulant use and the onset of pneumonia during the recovery phase. [12,13]The aim of this study was to investigate whether the use of pre-injury anti-platelets is a risk factor for the development of complications in blunt chest wall trauma patients

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