Prospective study on incidence of adult respiratory distress syndrome in blunt injury chest

Authors

  • Balamurugan C. Department of General Surgery, Stanley Medical College, Chennai, Tamil Nadu, India http://orcid.org/0000-0002-1733-1346
  • Hari Narayan M. Department of General Surgery, Stanley Medical College, Chennai, Tamil Nadu, India
  • Seetha G. Department of General Surgery, Stanley Medical College, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20223598

Keywords:

ARDS, Blunt trauma, Hemopneumothorax, Mechanical ventilation

Abstract

Background: This study was done to find out prospectively the incidence of adult respiratory distress syndrome (ARDS) in a random group of patients sustaining blunt trauma to the chest of any etiology and to study the factors involved in its causation and outcome.

Methods: Totally 150 patients who admitted in surgical wards and casualty of Stanley Medical College, Tamil Nadu during the period of March 2021 to February 2022 were studied. A thorough clinical examination of the patient was then done to identify any injury to the organs in the chest. This was then followed by investigations if the patient was stable enough not to warrant any emergency surgical intervention and data were collected outcomes were studied.

Results: Out of 150 patients, 74 of them had road traffic accidents, 39 of them had history of assault, 32 of them had fall from height regarding clinical manifestations 34 of them had dyspnea, 58 of them had single rib fracture, 48 of them had multiple rib fractures, 32 of them had pneumothorax, 19 of them had hemothorax, 8 of them had hemopneumothorax, 34 of them had flail chest, 20 of them had lung contusion 2 of them had diaphragmatic injury. In view of outcome, out of 150 patients, one of them had ARDS, 47 of them had thoracostomy, two of them had mechanical ventilation, one of them had laparotomy and seven of them died.

Conclusions: According to this study, the incidence of ARDS in blunt injury of chest was <1% in this study. Road traffic accidents have been the most common reason for blunt injury of chest.

References

Jones KW. Thoracic trauma. Surg Clin. 1980;60:957-81.

Centers for Disease Control and Prevention. Ten leading causes of death and injury. https://www.cdc.gov/injury/wisqars/LeadingCauses.html. Accessed on 1 March 2022.

LoCicero J, Mattox KL. Epidemiology of chest trauma. Surg Clin. 1989;69:15-9.

Broderick SR. Hemothorax: etiology, diagnosis, and management. Thorac Surg Clin. 2013;23:89-96.

Khandhar SJ, Johnson SB, Calhoon JH. Overview of thoracic trauma in the United States. Thorac Surg Clin. 2007;17:1-9.

Milisavljevic S, Spasic M, Arsenijevic M. Thoracic trauma. In: Cagini L, ed. Current Concepts in General Thoracic Surgery. InTech; 2012.

Marts B, Durham R, Shapiro M, Mazuski JE, Zuckerman D, Sundaram M, et al. Computed tomography in the diagnosis of blunt thoracic injury. Am J Surg. 1994;168(6):688-92.

Blair E, Topuzlu C, Davis JH. Delayed or missed diagnosis in blunt chest trauma. J Trauma. 1971;11:129-45.

Harrison M. Traumatic pneumothorax: a review of current practices. Br J Hosp Med. 2014;75:132-5.

Demirhan R, Onan B, Oz K, Halezeroglu S. Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interact Cardiovasc Thorac Surg. 2009;9(3):450-3.

Eghbalzadeh K, Sabashnikov A, Zeriouh M, Choi YH, Bunck AC, Mader N, et al. Blunt chest trauma: a clinical chameleon. Heart. 2018;104(9):719-24.

Pain management in blunt thoracic trauma (BTT): an evidence-based outcome evaluation. 2nd Review. Eastern Association for the Surgery of Trauma; 2003.

Cubasch H, Degiannis E. The deadly dozen of chest trauma. Cont Med Educ. 2004;22.

Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients- still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017;25(1):1-6.

Chadha TS, Cohn MA. Noninvasive treatment of pneumothorax with oxygen inhalation. Respiration. 1983;44:147-52.

Daly RC, Mucha P, Pairolero PC, Farnell MB. The risk of percutaneous chest tube thoracostomy for blunt thoracic trauma. Ann Emerg Med. 1985;14(9):865-70.

Simon BJ, Cushman J, Barraco R, Lane V, Luchette FA, Miglietta M, et al. Pain management guidelines for blunt thoracic trauma. J Trauma Acute Care Surg. 2005;59(5):1256-67.

Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury. 2012;43:8-17.

Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37:975-9.

Manay P, Satoskar RR, Karthik V, Prajapati RP. Studying morbidity and predicting mortality in patients with blunt chest trauma using a novel clinical score. J Emerg Trauma Shock. 2017;10(3):128.

Ekpe EE, Eyo C. Determinants of mortality in chest trauma patients. Niger J Surg. 2014;20:30-4.

Emircan S, Özgüç H, Aydin ŞA, Özdemir F, Köksal Ö, Bulut M. Factors affecting mortality in patients with thorax trauma. Ulus Travma Acil Cerrahi Derg. 2011;17:329-33.

Dougall AM, Paul ME, Finley RJ, Holliday RL, Coles JC, Duff JH. Chest trauma- current morbidity and mortality. J Trauma Acute Care Surg. 1977;17(7):547-53.

Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54:478-85.

Kulshrestha P, Munshi I, Wait R. Profile of chest trauma in a level I trauma center. J Trauma. 2004;57:576-81.

Roy N, Kizhakke Veetil D, Khajanchi MU, Kumar V, Solomon H, Kamble J, et al. Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths. BMC Health Serv Res. 2017;17:142.

Chan O, Hiorns M. Chest trauma. Eur J Radiol. 1996;23:23-34.

Haider AH, Chang DC, Haut ER, Cornwell III EE, Efron DT. Mechanism of injury predicts patient mortality and impairment after blunt trauma. J Surg Res. 2009;153(1):138-42.

Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imag. 2011;2:281-95.

Wintermark M, Schnyder P. Introduction to blunt trauma of the chest. In: Schnyder P, Wintermark M, eds. Radiology of Blunt Trauma of the Chest. Berlin, Heidelberg: Springer Berlin Heidelberg; 2000:1-7.

Cassuto J, Ezuddin N, Danton G. Blunt chest trauma: a radiologic approach and review. Curr Radiol Rep. 2018;6:23.

Chen R, Gabler HC. Risk of thoracic injury from direct steering wheel impact in frontal crashes. J Trauma Acute Care Surg. 2014;76:1441-6.

Newgard CD, Lewis RJ, Kraus JF. Steering wheel deformity and serious thoracic or abdominal injury among drivers and passengers involved in motor vehicle crashes. Ann Emerg Med. 2005;45:43-50.

Yadollahi M, Arabi AH, Mahmoudi A, Zamani M, Farahmand M. Blunt thoracic injury mortality and clinical presentation. Trauma Monthly. 2018;23(4).

Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthopaed. 2009;33(5):1425-33.

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Published

2022-12-30

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Original Research Articles