Thoraco-abdominal injuries among patients presenting with trauma

Abstract

Background: Globally, injuries contribute to around 10% of total deaths, and in India, to 13%–18%. Among all injury-related deaths, thoraco-abdominal trauma is the second most common cause of death. The aim of the study was to determine the outcomes of patients with thoraco-abdominal injuries presenting to a tertiary-level emergency department (ED) in South India. The study also aimed to verify the impact of extended-focused assessment with sonography in trauma (e-FAST) positivity on outcomes. Materials and Methods: A prospective observational study was conducted over 3 months. A cohort of patients presenting to the ED with abdomino-thoracic trauma were studied. Results: During the study period, we received 1216 trauma patients to our ED. 241 (19.8%) of them had thoraco-abdominal trauma. 158 (65.6%) patients had thoracic injuries and 183 (75.9%) patients had abdominal injuries. Among patients with thoracic injuries, 55 (34.8%) had hemothorax, 33 (20.9%) had pneumothorax, 30 (19%) had lung contusions, 64 (40.5%) had rib fractures, and 2 (1.2%) had pericardial effusions. Among patients with abdominal injuries, 33 (18%) had solid organ injuries, 68 (37.2%) had free fluid being present, and 3 (1.6%) had bowel injuries. 209 (86.7%) patients underwent e-FAST examination, of which 68 (32.5%) were e-FAST positive and 141 (67.5%) were e-FAST negative. Among e-FAST-positive patients, 54 (79.8%) needed admission, 3 (4.4%) were discharged from ED, and 4 (7.3%) died. Among e-FAST-negative patients, 80 (56.7%) needed admission, 54 (38.3%) were discharged from ED, and 1 (0.7%) patient died. 7 (10.2%) patients in the e-FAST-positive group and 15 (10.6%) in the e-FAST-negative group were discharged against medical advice. Systolic blood pressure <90, heart rate <60 and >100, Glasgow coma score ≤8, blood transfusion in the ED, and positive e-FAST were associated with increased risk of mortality. Conclusion: The study showed that abdominal trauma is more in two-wheeler riders and among adult males. e-FAST is a simple tool that can be used in the ED to timely recognize thoraco-abdominal trauma. Patients with e-FAST being positive are at an increased risk of adverse outcomes.