Thoracic Abbreviated Injury Scale Research Articles

Surgical fixation of rib fractures improves 30-day survival after significant chest injury : an analysis of ten years of prospective registry data from England and Wales.

The last decade has seen a marked increase in surgical rib fracture fixation (SRF). The evidence to support this comes largely from retrospective cohorts, and adjusting for the effect of other injuries sustained at the same time is challenging. This study aims to assess the impact of SRF after blunt chest trauma using national prospective registry data, while controlling for other comorbidities and injuries. A ten-year extract from the Trauma Audit and Research Network formed the study sample. Patients who underwent SRF were compared with those who received supportive care alone. The analysis was performed first for the entire eligible cohort, and then for patients with a serious (thoracic Abbreviated Injury Scale (AIS) ≥ 3) or minor (thoracic AIS < 3) chest injury without significant polytrauma. Multivariable logistic regression was performed to identify predictors of mortality. Kaplan-Meier estimators and multivariable Cox regression were performed to adjust for the effects of concomitant injuries and other comorbidities. Outcomes assessed were 30-day mortality, length of stay (LoS), and need for tracheostomy. A total of 86,838 cases were analyzed. The rate of SRF was 1.2%. SRF significantly reduced risk of mortality (odds ratio (OR) 0.27 (95 confidence interval (CI) 0.128 to 0.273); p < 0.001) and need for tracheostomy (OR 0.22 (95% CI 0.191 to 0.319); p < 0.001) after adjustment for other covariables across the whole cohort. SRF remained protective in patients with a serious chest injury (hazard ratio (HR) 0.24 (95% CI 0.13 to 0.45); p < 0.001). The benefit in more minor chest injury was less clear. Mean LoS for patients who survived was longer in the SRF group (24.29 days (SD 26.54) vs 16.60 days (SD 26.35); p < 0.001). SRF reduces mortality after significant chest trauma associated with both major and minor polytrauma. The rate of fixation in the UK is low and potentially underused as a treatment for severe chest wall injury. Cite this article: Bone Joint J2022;104-B(6):729-735.

Acute kidney injury in severely injured patients admitted to the intensive care unit

BackgroundOur objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury (AKI) in severely injured patients admitted to the intensive care unit (ICU) for whom creatine kinase (CK) levels were available.MethodsFor this retrospective observational study, we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili (FVL) University Hospital. Our primary outcome was the incidence of AKI. Multivariate regression analysis was used to assess risk factors for this outcome.ResultsA total of 315 patients were included. The trauma mechanisms were blunt (n = 130), penetrating (n = 66) and blast (n = 44) trauma. The median (interquartile range, IQR) of injury severity score (ISS) was 21 (16–29). AKI developed in 75 patients (23.8%). Multivariate regression analysis revealed that the thoracic abbreviated injury scale (AIS) value (median (IQR) in the AKI group: 3 (0–4)), Acute Physiology and Chronic Health Evaluation (APACHE II) score (median (IQR) in the AKI group: 18 (10–27)), CK greater than 5000 U/L, lactic acid concentration at admission, and dobutamine administration were independently associated with AKI.ConclusionWe found that age, APACHE II score, thoracic trauma, lactic acidosis, and dobutamine administration were independently associated with AKI. Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.

Impact of blunt chest trauma on outcome after traumatic brain injury\u2013 a matched-pair analysis of the TraumaRegister DGU\xae

BackgroundTraumatic brain injury (TBI) is associated with high rates of long-term disability and mortality. Our aim was to investigate the effects of thoracic trauma on the in-hospital course and outcome of patients with TBI.MethodsWe performed a matched pair analysis of the multicenter trauma database TraumaRegisterDGU® (TR-DGU) in the 5-year period from 2012 to 2016. We included adult patients (≥18 years of age) with moderate to severe TBI (abbreviated injury scale (AIS)= 3–5). Patients with isolated TBI (group 1) were compared to patients with TBI and varying degrees of additional blunt thoracic trauma (AISThorax= 2–5) (group 2). Matching criteria were gender, age, severity of TBI, initial GCS and presence/absence of shock. The χ2-test was used for comparing categorical variables and the Mann-Whitney-U-test was chosen for continuous parameters. Statistical significance was defined by a p-value < 0.05.ResultsA total of 5414 matched pairs (10,828 patients) were included. The presence of additional thoracic injuries in patients with TBI was associated with a longer duration of mechanical ventilation and a prolonged ICU and hospital length of stay. Additional thoracic trauma was also associated with higher mortality rates. These effects were most pronounced in thoracic AIS subgroups 4 and 5. Additional thoracic trauma, regardless of its severity (AISThorax ≥2) was associated with significantly decreased rates of good neurologic recovery (GOS = 5) after TBI.ConclusionsChest trauma in general, regardless of its initial severity (AISThorax= 2–5), is associated with decreased chance of good neurologic recovery after TBI. Affected patients should be considered “at risk” and vigilance for the maintenance of optimal neuro-protective measures should be high.

Effects of hospital-acquired pneumonia on long-term recovery and hospital resource utilization following moderate to severe traumatic brain injury.

Individuals with traumatic brain injury (TBI) have extended inpatient hospital stays that include prolonged mechanical ventilation, increasing risk for infections, including pneumonia. Studies show the negative short-term effects of hospital-acquired pneumonia (HAP) on hospital-based outcomes; however, little is known of its long-term effects. A prospective cohort study was conducted. National Trauma Databank and Traumatic Brain Injury Model Systems were merged to derive a cohort of 3,717 adults with moderate-to-severe TBI. Exposure data were gathered from the National Trauma Databank, and outcomes were gathered from the Traumatic Brain Injury Model Systems. The primary outcome was the Glasgow Outcome Scale-Extended (GOS-E), which was collected at 1, 2, and 5 years postinjury. The GOS-E was categorized as favorable (>5) or unfavorable (≤5) outcomes. A generalized estimating equation model was fitted estimating the effects of HAP on GOS-E over the first 5 years post-TBI, adjusting for age, race, ventilation status, brain injury severity, injury severity score, thoracic Abbreviated Injury Scale score of 3 or greater, mechanism of injury, intraventricular hemorrhage, and subarachnoid hemorrhage. Individuals with HAP had a 34% (odds ratio, 1.34; 95% confidence interval, 1.15-1.56) increased odds for unfavorable GOS-E over the first 5 years post-TBI compared with individuals without HAP, after adjustment for covariates. There was a significant interaction between HAP and follow-up, such that the effect of HAP on GOS-E declined over time. Sensitivity analyses that weighted for nonresponse bias and adjusted for differences across trauma facilities did not appreciably change the results. Individuals with HAP spent 10.1 days longer in acute care and 4.8 days longer in inpatient rehabilitation and had less efficient functional improvement during inpatient rehabilitation. Individuals with HAP during acute hospitalization have worse long-term prognosis and greater hospital resource utilization. Preventing HAP may be cost-effective and improve long-term recovery for individuals with TBI. Future studies should compare the effectiveness of different prophylaxis methods to prevent HAP. Prospective cohort study, level III.

Predictors of Change in Functional Outcome at six months and twelve months after Severe Injury: A Retrospective Cohort Study

BackgroundThere is increasing focus on long-term survival, function and quality-of-life for trauma patients. There are few studies tracking longitudinal changes in functional outcome over time. The goal of our study was to compare the Glasgow Outcome Scale-Extended (GOSE) at 6 months and 12 months in blunt trauma survivors with an Injury Severity Score (ISS) of more than 15.MethodsUsing the Singapore National Trauma Registry 2011–2013, patients with 6-month GOSE and 12-month GOSE scores were analysed. Patients were grouped into three categories—those with the same score at 6 months and 12 months, an improvement in score, and a worse score at 12 months. Ordinal regression was used to identify risk factors for improved score. Patients with missing scores at either 6 months or 12 months were excluded.ResultsWe identified 478 patients: 174 had an improvement in score, 233 stayed the same, and 71 had worse scores at 12 months compared to 6 months. On univariate ordinal regression, the following variables were associated with same or better function at 12-months compared to 6-months: male gender, being employed pre-injury, thoracic Abbreviated Injury Scale (AIS) of 3 or more, anatomical polytrauma (AIS of 3 or more in 2 or more body regions), and road traffic injury mechanism. Older age, low fall, increasing Charlson comorbidity scores, new injury severity score, and head and neck AIS of 3 or more were associated with worse function at 12 months compared to 6 months. ISS and revised trauma score were not significant predictors on univariate or multivariable analysis.On multivariable ordinal regression, motor vehicle mechanism (OR 2.78, 1.51–5.12, p = 0.001) was associated with improved function, while male gender (OR 1.36, 95% CI 1.02–1.82, p = 0.039) predicted improved function at 12 months.ConclusionsFemales experience worse functional outcomes at 12 months, potentially due to majority of female injuries being low falls in the elderly. In contrast, motor vehicle injury patients had better functional outcomes at 12 months. Additional interventional strategies for high-risk groups should be explored.

Driver injury in near- and far-side impacts: Update on the effect of front passenger belt use

ABSTRACTPurpose: This is a study that updates earlier research on the influence of a front passenger on the risk for severe driver injury in near-side and far-side impacts. It includes the effects of belt use by the driver and passenger, identifies body regions involved in driver injury, and identifies the sources for severe driver head injury.Methods: 1997–2015 NASS-CDS data were used to investigate the risk for Maximum Abbreviated Injury Scale (MAIS) 4 + F driver injury in near-side and far-side impacts by front passenger belt use and as a sole occupant in the driver seat. Side impacts were identified with GAD1 = L or R without rollover (rollover ≤ 0). Front-outboard occupants were included without ejection (ejection = 0). Injury severity was defined by MAIS and fatality (F) by TREATMNT = 1 or INJSEV = 4. Weighted data were determined. The risk for MAIS 4 + F was determined using the number of occupants with known injury status MAIS 0 + F. Standard errors were determined.Results: Overall, belted drivers had greater risks for severe injury in near-side than far-side impacts. As a sole driver, the risk was 0.969 ± 0.212% for near-side and 0.313 ± 0.069% for far-side impacts (P < .005). The driver's risk was 0.933 ± 0.430% with an unbelted passenger and 0.596 ± 0.144% with a belted passenger in near-side impacts. The risk was 2.17 times greater with an unbelted passenger (NS). The driver's risk was 0.782 ± 0.431% with an unbelted passenger and 0.361% ± 0.114% with a belted passenger in far-side impacts. The risk was 1.57 times greater with an unbelted passenger (P < .10). Seat belt use was 66 to 95% effective in preventing MAIS 4 + F injury in the driver. For belted drivers, the head and thorax were the leading body regions for Abbreviated Injury Scale (AIS) 4+ injury. For near-side impacts, the leading sources for AIS 4+ head injury were the left B-pillar, roof, and other vehicle. For far-side impacts, the leading sources were the other occupant, right interior, and roof (8.5%).Conclusions: Seat belt use by a passenger lowered the risk of severe driver injury in side impacts. The reduction was 54% in near-side impacts and 36% in far-side impacts. Belted drivers experienced mostly head and thoracic AIS 4+ injuries. Head injuries in the belted drivers were from contact with the side interior and the other occupant, even with a belted passenger.

Factors associated with in-hospital outcomes in 594 consecutive patients suffering from severe blunt chest trauma.

Blunt thoracic injury is a common cause for hospital admission after trauma. The effect of the number of rib fractures on the outcome is controversial. In this study, our hypothesis was that an increasing number of rib fractures correlates with mortality and hospital resource utilization. In addition to mortality, our focus was on the length of stay at hospital and in the intensive care unit, ventilator days, and the days in continuous positive airway pressure. The present investigation is a retrospective study from a single trauma center. The study includes patients with severe thoracic injury (thoracic Abbreviated Injury Scale (AIS) > 2) admitted to hospital after blunt trauma. Patients with isolated thoracic spine injuries and patients who were dead on arrival were excluded. Vital signs, laboratory results on admission, given care, intensive care unit and hospital length of stay, injuries, and in-hospital mortality were collected for the study. A total of 594 patients from a 5-year period (2003-2007) were included in the study. The mean age of the patients was 45 years, and 76.9% of the patients were males. The average Injury Severity Score was 22, and the patients had on average 5.5 injuries. Overall mortality was 6.4%. In the multivariate analysis, the mortality was associated with base excess and tromboplastin time in admission. The number of rib fractures did not correlate with the outcome measures, but the presence of bilateral rib fractures correlated with the outcome measures other than mortality. The number of rib fractures does not correlate with mortality or the length of stay in the intensive care unit in blunt trauma patients with severe thoracic injury. Mortality in these patients correlated with the degree of hypoperfusion (base excess) and coagulation abnormalities (tromboplastin time) on admission.

Epidemiology and risk factors of multiple-organ failure after multiple trauma

In the severely injured who survive the early posttraumatic phase, multiple-organ failure (MOF) is the main cause of morbidity and mortality. An enhanced prediction of MOF might influence individual monitoring and therapy of severely injured patients. We performed a retrospective analysis of a nationwide prospective database, the TraumaRegister DGU of the German Trauma Society. Patients with complete data sets (2002-2011) and a relevant trauma load (Injury Severity Score [ISS] ≥ 16), who were admitted to an intensive care unit, were included. Of a total of 31,154 patients enclosed in this study, 10,201 (32.7%) developed an MOF according to the Sequential Organ Failure Assessment score. During the study period, mortality of all patients decreased from 18.1% in 2002 to 15.3% in 2011 (p < 0.001). Meanwhile, MOF occurred significantly more often (24.6% in 2002 vs. 31.5% in 2011, p < 0.001), but mortality of MOF patients decreased (42.6% vs. 33.3%, p < 0.001). MOF patients who died survived 2 days less (11 days in 2002 vs. 8.9 days in 2011, p < 0.001). Independent risk factors for the development of MOF following severe trauma were age, ISS, head Abbreviated Injury Scale (AIS) score of 3 or higher, thoracic AIS score of 3 or higher, male sex, Glasgow Coma Scale (GCS) score of 8 or less, mass transfusion, base excess of less than -3, systolic blood pressure less than 90 mm Hg at admission, and coagulopathy. Over one decade, we observed an ongoing decrease of mortality after multiple trauma, accompanied by decreasing mortality in the subgroup with MOF. However, incidence of MOF in the severely injured increased significantly. Thus, MOF after multiple trauma remains a challenge in intensive care. The risk factors from multivariate analysis could be instrumental in anticipating the early development of MOF. Furthermore, a reliable prediction model might be supportive for patient enrolment in trauma studies, in which MOF marks the primary end point. Epidemiologic study, level III.

Comparing clinical predictors of deep venous thrombosis versus pulmonary embolus after severe injury

The traditional paradigm is that deep venous thrombosis (DVT) and pulmonary embolus (PE) are different temporal phases of a single disease process, most often labeled as the composite end point venous thromboembolism (VTE). However, we theorize that after severe blunt injury, DVT and PE may represent independent thrombotic entities rather than different stages of a single pathophysiologic process and therefore exhibit different clinical risk factor profiles. We examined a large, multicenter prospective cohort of severely injured blunt trauma patients to compare clinical risk factors for DVT and PE, including indicators of injury severity, shock, resuscitation parameters, comorbidities, and VTE prophylaxis. Independent risk factors for each outcome were determined by cross-validated logistic regression modeling using advanced exhaustive model search procedures. The study cohort consisted of 1,822 severely injured blunt trauma patients (median Injury Severity Score [ISS], 33; median base deficit, -9.5). Incidence of DVT and PE were 5.1% and 3.9%, respectively. Only 9 (5.7%) of 73 patients with a PE were also diagnosed with DVT. Independent risk factors associated with DVT include prophylaxis initiation within 48 hours (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.36-0.90) and thoracic Abbreviated Injury Scale (AIS) score of 3 or greater (OR, 1.82; 95% CI, 1.12-2.95), while independent risk factors for PE were serum lactate of greater than 5 (OR, 2.33; 95% CI, 1.43-3.79) and male sex (OR, 2.12; 95% CI, 1.17-3.84). Both DVT and PE exhibited differing risk factor profiles from the classic composite end point of VTE. DVT and PE exhibit differing risk factor profiles following severe injury. Clinical risk factors for diagnosis of DVT after severe blunt trauma include the inability to initiate prompt pharmacologic prophylaxis and severe thoracic injury, which may represent overall injury burden. In contrast, risk factors for PE are male sex and physiologic evidence of severe shock. We hypothesize that postinjury DVT and PE may represent a broad spectrum of pathologic thrombotic processes as opposed to the current conventional wisdom of peripheral thrombosis and subsequent embolus.

Comparing clinical predictors of deep venous thrombosis versus pulmonary embolus after severe injury: A new paradigm for posttraumatic venous thromboembolism?

BACKGROUND: The traditional paradigm is that deep venous thrombosis (DVT) and pulmonary embolus (PE) are different temporal phases of a single disease process, most often labeled as the composite end point venous thromboembolism (VTE). However, we theorize that after severe blunt injury, DVT and PE may represent independent thrombotic entities rather than different stages of a single pathophysiologic process and therefore exhibit different clinical risk factor profiles. METHODS: We examined a large, multicenter prospective cohort of severely injured blunt trauma patients to compare clinical risk factors for DVT and PE, including indicators of injury severity, shock, resuscitation parameters, comorbidities, and VTE prophylaxis. Independent risk factors for each outcome were determined by cross-validated logistic regression modeling using advanced exhaustive model search procedures. RESULTS: The study cohort consisted of 1,822 severely injured blunt trauma patients (median Injury Severity Score [ISS], 33; median base deficit, -9.5). Incidence of DVT and PE were 5.1% and 3.9%, respectively. Only 9 (5.7%) of 73 patients with a PE were also diagnosed with DVT. Independent risk factors associated with DVT include prophylaxis initiation within 48 hours (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.36–0.90) and thoracic Abbreviated Injury Scale (AIS) score of 3 or greater (OR, 1.82; 95% CI, 1.12–2.95), while independent risk factors for PE were serum lactate of greater than 5 (OR, 2.33; 95% CI, 1.43–3.79) and male sex (OR, 2.12; 95% CI, 1.17–3.84). Both DVT and PE exhibited differing risk factor profiles from the classic composite end point of VTE. CONCLUSION: DVT and PE exhibit differing risk factor profiles following severe injury. Clinical risk factors for diagnosis of DVT after severe blunt trauma include the inability to initiate prompt pharmacologic prophylaxis and severe thoracic injury, which may represent overall injury burden. In contrast, risk factors for PE are male sex and physiologic evidence of severe shock. We hypothesize that postinjury DVT and PE may represent a broad spectrum of pathologic thrombotic processes as opposed to the current conventional wisdom of peripheral thrombosis and subsequent embolus. LEVEL OF EVIDENCE: Prognostic study, level III.

Prevalence and mortality of severe chest trauma in Three Gorges Area of China

To analyze the epidemiological features of severe chest trauma (SCT) and investigate the risk factor of its mortality in the Three Gorges Area of China. The clinical data of 1834 SCT patients who were admitted in three hospitals in this area from January 1990 to December 2009 were retrospectively reviewed. Th epidemiological features of SCT were analyzed using a database. Stepwise logistic regression analysis was used to analyze 15 possible risk factors affecting mortality. The morbidity rates of blunt trauma (68.5% vs. 74.7%,p=0.006) and sharp instrument injury (12.2% vs. 15.9%,p=0.039) showed significant differences before and after 2000. The pre-hospital time [(3.45±2.38)h vs. (2.20±4.39)h,p<0.01] and transfer rate (32.39% vs. 36.80%,p=0.01) significantly improved. The thoracic Abbreviated Injury Scale (AIS)(3.56±0.71vs. 3.43±0.58,p<0.01)score and Revised Trauma Score (RTS)(7.14±2.18 vs. 6.93±1.07,p<0.01) significantly increased. Treatment for pulmonary infection (12.63±4.79 vs. 17.16±6.41,p=0.019) and hemorrhagic shock (2.4±0.75 vs. 3.4±1.34,p=0.008 )was significantly improved. The leading cause of death was hypovolemic shock (59.41%). The independent rik factors of death among these SCT patients included: hemorrhagic shock (B=1.710,OR=1.291,p=0.001), multiple organ dysfunction syndrome (B=3.453,OR=1.028,p<0.001), pulmonary infection(B=2.396,OR=10.941,p<0.001), abdominal organ injury(B=1.542,OR=1.210,p=0.005), and thorax AIS(B=0.487,OR=1.622,p<0.001). The prevalence of SCT shows an increasing trend in the Three Gorges Area in recent years, but with a decreased rate of complications and improved treatment. Age, complications, thorax AIS, and GCS are useful prognostic indicators.

Resuscitation Before Stabilization of Femoral Fractures Limits Acute Respiratory Distress Syndrome in Patients With Multiple Traumatic Injuries Despite Low Use of Damage Control Orthopedics

Femoral shaft fractures are associated with acute respiratory distress syndrome (ARDS). The idea that primary intramedullary nailing increases the incidence of ARDS has theoretical support. Our approach to treating femoral fractures in patients with multiple traumatic injuries is to perform reamed nailing after adequate resuscitation has been shown by normalizing lactate plus optimized ventilatory and hemodynamic parameters. Damage control orthopedics (DCO) with primary external fixation usually is reserved for those rare patients who do not respond to resuscitation. Our hypothesis was that this approach yields a low rate of ARDS. A prospective trauma database was searched for all femoral shaft fractures treated at a Level I trauma center during a 3-year period, yielding 582 patients. Exclusion criteria included death before treatment (n = 9), age younger than 16 years (n = 16), age older than 65 years (n = 35), fractures that were not amenable to nail fixation (n = 31), shaft fractures treated with a plate (n = 3), patients with bilateral femoral shaft fractures who had a primary nail placed in one femur and an external fixator on the other limb (n = 1), and patients with an Injury Severity Score (ISS) <or=17 (n = 260), leaving 227 patients in the final study group. We defined ARDS as a mean partial pressure of oxygen/fraction of inspired oxygen <200 for 5 or more consecutive days. We compared our results with the results of a similar design in the literature. Of the 227 patients with ISS >17, only 12% were initially treated with DCO, and 88% were treated with primary reamed nailing. The 227 patients achieved successful early resuscitation as shown by lactate values that decreased significantly on the operative day compared with presenting values (p < 0.05). ARDS rates were low, including rates for the subgroup of patients with lung injury (thoracic Abbreviated Injury Scale score >2, n = 175) who were treated with nailing and had an ARDS rate of 2.0% and a death rate of 2.0%. The ARDS rate for the most severely injured patients who underwent nailing (ISS >28, thoracic Abbreviated Injury Scale score >2, n = 78) was only 3.3%, and 1.7% died. In the context of resuscitation before reamed intramedullary nailing of femoral shaft fractures, our rate of ARDS was lower (p < 0.001) than that of a similar study reported in the literature in which the DCO approach was used in up to 36% of patients (p < 0.001) and was more in keeping with previously reported rates of ARDS. This remained true despite frequent use of early reamed femoral nailing and infrequent use of DCO. An explanation for the discrepancy between the centers might be differences in preoperative resuscitation or medical care provided to treat shock.

Functional and survival outcomes in traumatic blunt thoracic aortic injuries: An analysis of the National Trauma Databank

Blunt thoracic aortic injury (BAI) remains a leading cause of trauma deaths, and off-label use of endovascular devices has been increasingly utilized in an effort to reduce the morbidity and mortality in this population. Utilizing a nationwide database, we determined the incidence of BAI, and analyzed both functional and survival outcomes at discharge compared with matched controls. Patients with BAI were identified by International Classification of Disease-9 codes from the National Trauma Data Bank (Version 6.2), 2000-2005. Patients were analyzed based on aortic repair, associated physiologic burden, and coexisting injuries. Control groups were matched by age, mechanism, major thoracic Abbreviated Injury Scale score (AIS >/= 3), major head AIS, and major abdominal AIS. Outcomes were assessed using the functional independence measure (FIM) score and overall mortality. FIM scores were scored from 1 (full assistance required) to 4 (fully independent) for three categories: feeding, locomotion, and expression. During the study period, 3,114 patients with BAI were identified among 1.1 million trauma admissions for an overall incidence of 0.3%. One hundred thirteen (4%) were dead on arrival, and 599 (19%) died during triage. Of the patients surviving transport and triage (n = 2402), 29% had a concomitant major abdominal injury and 31% had a major head injury. Sixty-eight percent (1,642) underwent no repair, 28% (665) open aortic repair, and 4% (95) endovascular repair with associated mortality rates of 65%, 19%, and 18%, respectively (P < .05). Aortic repair independently improved survival when controlling for associated injuries and physiologic burden (odds ratio (OR) = 0.36; 95% confidence interval (CI), 0.24-0.54, P < .05). Compared with matched controls, BAI resulted in a higher mortality (55% vs. 15%, P < .05), and independently contributed to mortality (OR = 4.04; 95% CI, 3.53-4.63, P < .05). In addition, BAI patients were less likely to be fully independent for feeding (72% vs. 82%, P < .05), locomotion (33% vs. 55%, P < .05), and expression (80% vs 88%, P < .05). This manuscript is the first to define the incidence of BAI utilizing the NTDB. Remarkably, two-thirds of patients are unable to undergo attempts at aortic repair, which portends a poor prognosis. When controlling for associated injuries, blunt aortic injury independently impacts survival and results in poor function in those surviving to discharge.

Diagnosis and incidence of cardiac injury in children with blunt thoracic trauma.

Over a 20-month period, we prospectively studied 41 children with blunt thoracic trauma (BTT) to determine the incidence and morbidity of cardiac injury in this population. Four patients died, and the data were incomplete in 10, leaving 27 for analysis. Serial electrocardiograms (ECG) were abnormal in 36% of the patients studied, serial creatine phosphokinase isoenzyme (CK-MB) ratios were elevated in 31%, echocardiogram showed septal dysfunction in 14%, and pyrophosphate scan showed grade 1 uptake in 14%. There was poor correlation among tests, since only four patients had more than one abnormal test. There was no significant difference in Injury Severity Score or Thoracic Abbreviated Injury Scale between patients with and without abnormal investigations. No patient in the study developed arrhythmias or cardiac failure. In 13 trauma-related deaths undergoing autopsy over the same period, including the four with thoracic trauma, none had evidence of cardiac injury. These results indicate a striking lack of consistency in the diagnosis of posttraumatic cardiac injury in children using standard investigations. The absence of adverse cardiac events in surviving patients and the lack of autopsy evidence of cardiac injury in the trauma deaths suggest that the actual incidence and clinical significance of these lesions in children is lower than generally reported. Children with BTT should be followed clinically, and reliance on screening tests should be avoided.