Blunt Thorax Trauma Research Articles

Shock Index for the Prediction of Interventions and Mortality in Patients With Blunt Thoracic Trauma

IntroductionShock index (SI) is a bedside simple scoring tool; however, it has not yet been tested in blunt thorax trauma (BTT). We sought to evaluate the prognostic value of SI for chest interventions (thoracostomy tube or thoracotomy), blood transfusion, and mortality in patients with BTT. We hypothesized that high SI is associated with worse outcomes in patients with BTT. MethodsWe conducted a retrospective analysis of all BTT patients (chest Abbreviated Injury Score [AIS] > 1) hospitalized in a level 1 trauma center between 2011 and 2020. Patients with AIS >1 for head or abdominal injuries and patients undergoing open reduction and internal fixation surgery or penetrating injuries were excluded. Patients were categorized into two groups (low SI <0.80 versus high SI ≥0.80) based on the receiver operating characteristic curve analysis. Multivariable regression analysis was performed to identify the predictors of mortality. ResultsA total of 1645 patients were admitted with BTT; of them, 24.5% had high SI. The mean age was 39.2 ± 15.2 y, and most were males (91%). Patients with high SI were younger, had sustained severer injuries, and required more chest interventions (P = 0.001), blood transfusion (P = 0.001), and massive transfusion protocol activation (P = 0.001) compared with low SI group. The overall in-hospital mortality rate was 2.6%, which was more in the high SI group (8.2% versus 0.8%; P = 0.001). SI significantly correlated with age (r = −0.281), injury severity score (r = 0.418), Glasgow Come Score on arrival (r = −0.377), Trauma and Injury Severity Score (r = −0.144), Revised Trauma Score (r = −0.219), serum lactate (r = 0.434), blood transfusion units (r = 0.418), and chest AIS (r = 0.066). SI was an independent predictor of mortality (odds ratio 3.506; 95% confidence interval 1.389-8.848; P = 0.008), and this effect persisted after adjustment for chest intervention (odds ratio 2.923; 95% confidence interval 1.146-7.455; P = 0.02). ConclusionsThe present study highlights the prognostic value of SI as a rapid bedside tool to predict the use of interventions and the risk of mortality in patients with BTT. The study findings help the emergency physicians for early and appropriate risk stratification and triaging of patients with BTT.

Thoracic trauma promotes alpha-Synuclein oligomerization in murine Parkinson's disease

BackgroundSystemic and neuroinflammatory processes play key roles in neurodegenerative diseases such as Parkinson's disease (PD). Physical trauma which induces considerable systemic inflammatory responses, represents an evident environmental factor in aging. However, little is known about the impact of physical trauma, on the immuno-pathophysiology of PD. Especially blunt chest trauma which is associated with a high morbidity and mortality rate in the elderly population, can induce a strong pulmonary and systemic inflammatory reaction. Hence, we sought out to combine a well-established thoracic trauma mouse model with a well-established PD mouse model to characterize the influence of physical trauma to neurodegenerative processes in PD. MethodsTo study the influence of peripheral trauma in a PD mouse model we performed a highly standardized blunt thorax trauma in a well-established PD mouse model and determined the subsequent local and systemic response. ResultsWe could show that blunt chest trauma leads to a systemic inflammatory response which is quantifiable with increased inflammatory markers in bronchoalveolar fluids (BALF) and plasma regardless of the presence of a PD phenotype. A difference of the local inflammatory response in the brain between the PD group and non-PD group could be detected, as well as an increase in the formation of oligomeric pathological alpha-Synuclein (asyn) suggesting an interplay between peripheral thoracic trauma and asyn pathology in PD. ConclusionTaken together this study provides evidence that physical trauma is associated with increased asyn oligomerization in a PD mouse model underlining the relevance of PD pathogenesis under traumatic settings.

Localization of rib fractures following blunt thorax trauma and investigating the relationship between these and traumatic hemopneumothorax

Background: Thorax traumas form 20-25% of deaths resulting from trauma. In the young population, the most common reason for death resulting from trauma is thorax trauma. The investigation of blunt thorax trauma reveals that the most common reason in the young population is 'in-vehicle motor traffic accidents (IVMTA), while falls take the 1st place in the geriatric population. The relationship between the localization of rib fractures developing due to blunt thorax trauma and the resultant hemothorax, pneumothorax, or hemopneumothorax investigated, and results compared. Material and Method: Between the dates November 2018 and November 2019, thoracic computerized tomography views of a total of 81 patients who applied with blunt thorax trauma and rib fractures evaluated retrospectively. Rib fractures were divided into three as upper, middle and lower thoracic segments according to their localization. Results: The most common localization for rib fracture was the middle thoracic segment with 57 (70.3%) patients. The mean hospitalization period was 5.4 (range: 1-24) days. Additional pathological findings were hemothorax, pneumothorax, and hemopneumothorax in 20 (24.7%), 16 (19.8%), and 5 (6.2%) patients, respectively. Among thoracic segments where rib fractures encountered, the upper thoracic segment most commonly led to hemothorax and pneumothorax with 11 (32.3%) and 8 (23.5%) patients, respectively. Conclusion: The most common localization of rib fractures following blunt thorax trauma is the upper and middle thoracic segment. In the upper thoracic segment, emergency thorax surgery complications like hemothorax/pneumothorax follow posttraumatic rib fractures in the earlier term and are more common when compared to other segments. The segmental localization of rib fractures developing due to blunt thorax trauma is essential in terms of morbidities, and the decision of invasive or conservative treatment depends on this information.

Recent Developments in Mouse Trauma Research Models: A Mini-Review.

The urgency to investigate trauma in a controlled and reproducible environment rises since multiple trauma still account for the most deaths for people under the age of 45. The most common multiple trauma include head as well as blunt thorax trauma along with fractures. However, these trauma remain difficult to treat, partially because the molecular mechanisms that trigger the immediate immune response are not fully elucidated. To illuminate these mechanisms, investigators have used animal models, primarily mice as research subjects. This mini review aims to 1) emphasize the importance of the development of clinically relevant murine trauma research, 2) highlight and discuss the existing conflict between simulating clinically relevant situations and elucidating molecular mechanisms, 3) describe the advantages and disadvantages of established mouse trauma models developed to simulate clinically relevant situations, 4) summarize and list established mouse models in the field of trauma research developed to simulate clinically relevant situations.

Prediction of traumatic pathology by classifying thorax trauma using a hybrid method for emergency services

In recent years, data mining and algorithm-based methods have been used frequently for the prediction and diagnosis of various diseases. Traumas, being one of the significant health problems in the world, are also one of the most important causes of death. This study aims to predict the presence of traumatic pathology in the lung of the patients admitted to the emergency department due to blunt thorax trauma with no X-ray and computed tomography (CT) history by machine learning methods. The models developed in the study using the 5-fold cross-validation method are most accurately classified by the ensemble (voting) classifier, whether there is a pathology in X-ray (mean accuracy = 0.82) and CT (mean accuracy = 0.83). The K-nearest neighbourhood method classifies patients with pathology in X-ray by 83% accuracy, while the ensemble (voting) method classifies non-pathology patients by 94% accuracy in models. Of CT results, random forest, ensemble (voting), and ensemble (stacking) classifiers are precisely classified by 96%, while those patients with pathology are classified perspicuously by 77%. As a result, a mathematical framework using data mining methods was proposed based on estimating the X-ray and CT results for the thorax graph scan.

Influence of obesity on remodeling of lung tissue and organization of extracellular matrix after blunt thorax trauma

BackgroundPreviously, it has been shown that obesity is a risk factor for recovery, regeneration, and tissue repair after blunt trauma and can affect the rate of muscle recovery and collagen deposition after trauma. To date, lung tissue regeneration and extracellular matrix regulation in obese mice after injury has not been investigated in detail yet.MethodsThis study uses an established blunt thorax trauma model to analyze morphological changes and alterations on gene and protein level in lean or obese (diet-induced obesity for 16 ± 1 week) male C57BL/6 J mice at various time-points after trauma induction (1 h, 6 h, 24 h, 72 h and 192 h).ResultsMorphological analysis after injury showed lung parenchyma damage at early time-points in both lean and obese mice. At later time-points a better regenerative capacity of lean mice was observed, since obese animals still exhibited alveoli collapse, wall thickness as well as remaining filled alveoli structures. Although lean mice showed significantly increased collagen and fibronectin gene levels, analysis of collagen deposition showed no difference based on colorimetric quantification of collagen and visual assessment of Sirius red staining. When investigating the organization of the ECM on gene level, a decreased response of obese mice after trauma regarding extracellular matrix composition and organization was detectable. Differences in the lung tissue between the diets regarding early responding MMPs (MMP8/9) and late responding MMPs (MMP2) could be observed on gene and protein level. Obese mice show differences in regulation of extracellular matrix components compared to normal weight mice, which results in a decreased total MMP activity in obese animals during the whole regeneration phase. Starting at 6 h post traumatic injury, lean mice show a 50% increase in total MMP activity compared to control animals, while MMP activity in obese mice drops to 50%.ConclusionsIn conclusion, abnormal regulation of the levels of extracellular matrix genes in the lung may contribute to an aberrant regeneration after trauma induction with a delay of repair and pathological changes of the lung tissue in obese mice.

Evaluation of the Nexus X-ray rules in blunt thorax trauma.

There is still no agreed radiographic rule for the evaluation of blunt thoracic trauma. Emergency physicians want radiography according to their experience and examination findings. Various studies have been carried out on this subject and some of these studies have reached findings that can support the initial steps of the rules of radiography. One of them is the rule of Nexus thorax radiography rules. In this study, we aim to determine the accuracy of nexus thorax radiography rules. Our study was a prospective cohort study performed in the emergency department of our University Hospital. In this study, 690 patients were evaluated. As a result of our study, we observed that patients were asked for more thoracic trauma because of chest pain, palpation tenderness in the thorax and sudden deceleration mechanism and pathology was found in approximately 25% of all imaging. The most common pathology we observed was rib fracture. Approximately 45% of the patients underwent thorax CT, and thorax CT was the most frequently requested for the detailed examination. When we evaluate the patients according to nexus thorax radiography rules, it was seen that the mechanism of sudden deceleration, intoxication and the disturbing, painful injury was more important than other parameters. The overall sensitivity and specificity of Nexus thorax radiographs were found to be 98% and 38%, respectively. In the evaluation of blunt thoracic trauma, the rules of nexus thorax radiography are considered useful concerning pathological detection.

Age differences in blunt chest trauma: a cross-sectional study.

IntroductionTrauma is the most common cause of presentation to hospital emergency services. After extremity and cranial injuries, blunt thoracic trauma is the third most common injury.AimIn this study, we aimed to present and assess blunt chest trauma in adults aged below 65 and elderly (age ≥ 65).Material and methodsIn this study, 130 patients (86 young (age 18–64) and 44 elderly (age ≥ 65)) who applied to the emergency department with blunt thoracic trauma between October 2017 and October 2019 were evaluated retrospectively.ResultsOf the patients, 99 (76.1%) were male, and 31 (23.9%) were female. The mean age was 54.41 ±20.13 years, and the patients were between 18 and 95 years of age. The most common cause of blunt thoracic trauma in the elderly group was a fall (n = 27; 61.3%), while in-vehicle traffic accident was most common in the young group (n = 43; 50%). “Flail chest,” which is observed as a complication after multiple rib fractures, was present in 1 patient in the young group and in 10 patients in the elderly group; the difference was statistically significant (p > 0.05). Seven (5.3%) patients died. The mean hospital stay was 5.1 (1–60) days, which was borderline-significantly higher in the elderly group (p = 0.056).ConclusionsDue to its life-threatening properties, the detection of blunt thorax trauma is a priority among multiple-trauma patients. For this reason, an aggressive diagnosis and treatment approach is essential in the whole patient group, especially among the elderly.

Computed tomography features of traumatic pulmonary pseudocysts

Objectives: To discuss the radiological characteristics of traumatic pulmonary pseudocyst (TPP) detected by thorax computed tomography. Methods: Retrospective screening was made of 107 patients applied with thorax computed tomography due to blunt thoracic trauma between 2014 and 2017 at our hospital. Results: TPP was detected in 6 (5.6%) patients. The patients comprised 5 males and 1 female with a mean age of 28 years (range, 15-49 years). Blunt thorax trauma was caused by traffic accidents in 4 patients and a fall from height in 2 patients. Eleven (64.7%) of the lesions were located in the lower lobes. The most common finding associated with TPP was ground glass opacities, which were present in all of the patients and represented the parenchymal contusion. Conclusion: Thorax computed tomography is an effective and reliable method for early and definitive diagnosis of the rare development of TPP after blunt thoracic trauma.

Effects of Prior Psychosocial Trauma on Subsequent Immune Response After Experimental Thorax Trauma.

Overshooting inflammation during the early phase after blunt thorax trauma promotes the development of acute respiratory distress syndrome, multiple organ failure, and subsequent mortality. Given that individuals diagnosed with stress-related disorders are characterized by chronic low-grade inflammation, we hypothesize that "psychosocial traumatic preload" poses a risk factor for the abovementioned complications after thorax trauma.Here, we used the chronic subordinate colony housing (CSC) paradigm to induce "psychosocial traumatic preload" and systemic low-grade immune activation in male mice, indicated by elevated plasma concentrations of different inflammatory mediators. Subsequent thorax trauma was induced in anaesthetized mice by a single blast wave centered on the thorax; SHAM animals were exposed to anesthesia only. Mice were killed 2, 6, and 24 h after thorax trauma or SHAM treatment.Independent of thorax trauma, CSC caused an increase in adrenal weight, and a decrease in thymus weight, indicating that the stress paradigm worked reliably. Moreover, although lung histology was not affected by prior stress, CSC exposure aggravated the early immune response after thorax trauma, indicated by elevated myeloperoxidase lung concentrations in thorax trauma-exposed CSC versus respective single-housed control (SHC) mice (2 h). Furthermore, thorax trauma caused an increase in total bronchoalveolar lavage fluid (BAL) protein (24 h), BAL C5a (2 h), BAL cell counts (24 h), and BAL keratinocyte chemoattractant (6 h and 24 h) in CSC but not SHC mice.Our data indicate that repeated psychosocial traumatization during adulthood moderately aggravates the local immune response toward thorax trauma, but overall may be considered as a rather minor risk factor in terms of thorax trauma-associated complications.

Retrospective Analysis of 513 Cases Diagnosed with Rib Fracture Secondary to Blunt Thorax Trauma

Retrospective Analysis of 513 Cases Diagnosed with Rib Fracture Secondary to Blunt Thorax Trauma

The Usefulness of Early Surgical Rib Stabilization in Flail Chest

Background : Flail chest is a clinical condition observed in patients with blunt thorax trauma. Surgical stabilization methods performed on selected patients shorten the durations of mechanical ventilation and intensive care monitoring and significantly reduce the rates of ventilator-associated morbidity and mortality.Material and Method : Patients treated and diagnosed with flail chest between 2009 and 2014 were studied retrospectively.Results : There were two groups: 10 patients in the group treated surgically and 10 patients in the group treated non-surgically. The groups were similar in terms of age, ISS score, degree of pulmonary contusion, number of rib fractures and location of flail chest. There were no significant differences between the stabilization and non-surgical therapy groups in hospitalization and mechanical ventilation period, tracheostomies, hospital costs and mortality. However, there were significant differences in the intensive care period. The number of the patients who developed pneumonia was significantly lower in the stabilization group, and the difference was statistically significant.Conclusion : Early surgical rib stabilization in flail chest is a safe treatment method which has a low complication rate and can reduce the morbidity and mortality which develop from mechanical ventilation.

Ultrasonography as a better diagnostic efficiency in rib fracture

In this study, our aim was to demonstrate the need of use of ultrasonography in rib fractures in order not to face medicolegal problems. One hundred patients admitted to our emergency service with mild to moderate blunt thorax trauma were included in our study prospectively. The inclusion criteria were pain upon palpation of ribs, deep inspiration, coughing but no any other pathologies like a pneumothorax, hemothorax. All patients are evaluated with ultrasonography (USG) and direct X-rays. X-ray revealed rib fracture diagnosis in 45 of 100 patients. Rib fracture is determined with using USG in 47 of 55 patients who are agreed on lack of rib fracture with direct X-rays. USG evaluation performed by an experienced radiologist is necessary in rib fractures for early diagnosis, arranging the treatment, documentation and preventing medicolegal problems.

Antioxidant vitamins C, E and coenzyme Q10 vs Dexamethasone: comparisons of their effects in pulmonary contusion model

BackgroundThe goal of our study is to evaluate the effects of antioxidant vitamins (vitamin C and E), Coenzyme Q10 (CoQ10) and dexamethasone (Dxm) in experimental rat models with pulmonary contusion (PC).MethodsRats were randomly divided into six groups. Except for the control, all subgroups had a moderate pulmonary contusion. Animals in the group I and group II received intraperitoneal saline, group III received 10mg.kg-1 CoQ10 group IV received 100mg.kg-1 vitamin C, group V received 150mg.kg-1 vitamin E, and group VI received 10mg.kg-1 Dxm. Blood gas analysis, serum nitric oxide (NO) and malondialdehyde (MDA) levels as well as superoxide dismutase (SOD) activity assays, bronchoalveolar lavage (BAL) fluid and histopathological examination were performed.ResultsAdministration of CoQ10 resulted in a significant increase in PaO2 values compared with the group I (p = 0.004). Levels of plasma MDA in group II were significantly higher than those in the group I (p = 0.01). Early administration of vitamin C, CoQ10, and Dxm significantly decreased the levels of MDA (p = 0.01). Lung contusion due to blunt trauma significantly decreased SOD activities in rat lung tissue compared with group I (p = 0.01). SOD levels were significantly elevated in animals treated with CoQ10, Vitamin E, or Dxm compared with group II (p = 0.01).ConclusionsIn our study, CoQ10, vitamin C, vitamin E and Dxm had a protective effect on the biochemical and histopathological outcome of PC after experimental blunt thorax trauma.

Traumatic Tension Pneumopericardium

Tension pneumopericardium is a rare and life threatening condition which results from either penetrating or blunt thorax trauma. A 44-year-old man, who fell from the fifth floor of a building, had major trauma that consisted with hemorrhagic shock, pneumothorax and pneumopericardium, retroperitoneal hemorrhage, pelvic and lower extremity fractures. Multiple costal fractures, sternal fracture, right hemopneumothorax, massive air in the pericardial sac and diffuse subcutaneous emphysema were reported in the chest computed tomography. Pneumopericardium is usually self–limited but can progress into tension pneumopericardium causing cardiac tamponade. The drainage of pneumothorax could be the initial procedure in case of pneumothorax associated with pneumopericardium. However, emergent pericardiocentesis can be required for patients with resistant hypotension. Emergency physicians should consider this rare entity for the differential diagnosis of thorax trauma with shock and be familiar with its treatment options.

Secondary diaphragmatic rupture as a cause of worsening dyspnoea after blunt thorax trauma and consecutive pulmonary embolism

A 67-year-old woman had been wearing a seat-belt during a car accident. She was transferred to the trauma centre. During whole-body computed tomography (CT), bone fractures and relevant injuries of internal organs were ruled out. Three days after the accident, the patient suffered from acute respiratory distress. A …

Long-term sequelae following blunt thoracic trauma.

People experiencing blunt thoracic trauma may sustain multiple rib fractures, flail chest, cardiac or pulmonary contusions, injury to the great vessels, sternal fractures, clavicular fractures, neck injuries, and lacerations of the liver and/or spleen. Long-term sequelae from blunt chest trauma include chest wall deformities, persistent dyspnea, and cardiac, neurologic, or esophageal complications. Chronic pain, depression, and loss of functional status are also frequent components of recovery from trauma.

The expression of P-selectin in inflammatory and non-inflammatory lung tissue.

An initial attachment of leucocytes to blood vessel walls is mediated by selectins. A feature of adhesion mediated by P-selectin is the "rolling" of leucocytes on the endothelium. The time dependent expression of p-selectin in lung tissue was investigated in five groups of cases with different causes of death: carbon-monoxide and cyanide intoxication (n = 11), drowning (n = 5), hanging (n = 9), pneumonia (n = 13) and polytrauma with blunt thorax trauma (n = 14). In paraffin-embedded archival specimens immunostaining was achieved using an adapted APAAP-immunoperoxidase technique together with a wet autoclave method. P-selectin detection was scored by a semiquantitative method evaluating the intensity and incidence of positively stained endothelial cells. The distribution pattern of endothelial P-selectin of blood vessels in cases of pneumonia and septic shock were heterogenius and weak. In one case with lung contusion (survival time 3 h) moderate infiltrates of granulocytes were found near to septal and subpleural hemorrhages. In these inflammatory areas the positive endothelial immunostaining of small vessels was often weaker than in other lung segments or compared to the intensely stained platelets in corresponding vessels.

Cardiac damage after blunt chest trauma, diagnosed using CK-MB enzyme and electrocardiogram

In the present study, 78 patients with a blunt thorax trauma were examined. Fifty-four percent of the patients had been injured in traffic. Creatinine kinase (CK) and its isoenzymes (MM, MB and BB), ASAT, ALAT, ECG and thorax X-ray were taken. In 24% of the patients examined, the activity of serum MB isoenzyme was ≧ 6% of the total activity of CK, and in 40% no MB activity was observed. Pathological ECG changes were detected in 89% in the MB ≧ 6% group and in 32% in the MB = 0% group. ECG changes cannot be regarded as specific indicators of cardiac contusion. Arrhythmias, conduction defects, ST segment and T wave changes, and a pathologically long QT c interval were present significantly more often ( P < 0.01) in the MB ≧ 6% group than in the MB = 0% group. Roentgenologically, pulmonary contusion, cardiac dilatation and venous congestion-pulmonary edema were diagnosed more frequently in the MB ≧ 6% group ( P < 0.01) than in the MB = 0% group. Eleven of the patients died. A forensic autopsy was performed on these patients, and a macroscopic heart injury was detected in five of them. Serum MB activity had been found in all these five.