Long term management of thoracic trauma in a high frequency trauma center; what have we learned?

Background

One of the most frequently seen lethal causalities is the thoracic trauma (TT). We aim to distinguish risk factors affecting the outcome of TT to find the best way for its management.

Methods

Over a 12-year data were collected and retrospectively analyzed patients with TT. Two patients' groups were involved: Group I: patients managed between January 2003–December 2008. Group II: patients managed between January 2009–December 2014. Risk factors were analyzed.

Results

A total number of 630 thoracic trauma cases were admitted. Group I included 285 patients (197 males, their mean age 46 years). 345 patients were managed in Group II (251 males, their mean age 49 years). Higher thoracic trauma score (TTS), and higher abbreviated injury score (AIS thoracic) were associated with overall higher morbidity and mortality (p = .017). 94 (15%) of patients who had severe lung contusions showed a higher morbidity and mortality (p < .001). 23 (8%) patients had emergency thoracotomy in group I versus 14 (4%) patients in group II (p = .041). Overall mortality was 12.5% with higher incidence in group I (p = .024). Overall morbidity was 52% (n = 331) with a higher incidence in group I (p = .039). More young patients (<50 years) were frequently injured but showed fewer mortality rates (p = .014).

Conclusions

Optimal management is achievable in specialized centers under the supervision of an experienced thoracic surgeon. Early mobilization and repeated bronchoscopic examination resulted in a good outcome in most of the patients. Severe pulmonic injuries marked TTS and AIS thoracic scores, and also the age were independent prognostic factors for the outcome.