MORBIDITY AND MORTALITY AMONG PATIENTS SUSTAINING CHEST INJURY DUE TO BLUNT FORCE - THE DIFFERENCE BETWEEN YOUNG AND ELDERLY

Authors

  • Ambreen abid Jinnah Postgraduate Medical Centre , Karachi. Trainee post graduate in Department of Thoracic surgery , Ward 27
  • Tanveer Ahmad Jinnah Postgraduate Medical Centre , Karachi. Training post graduate in Department of Thoracic surgery Head Of Department Thoracic surgery , Ward 27
  • Pratikshya Thapaliya Jinnah Postgraduate Medical Centre , Karachi. Colleague , Trainee post graduate in Department of Thoracic surgery , Ward 27
  • Surrendar Dawani Jinnah Postgraduate Medical Centre , Karachi. Assistant Professor in Department of General surgery , Ward 21 General Surgical issues addressed.
  • Nazish Sikander Jinnah Postgraduate Medical Centre , Karachi. Colleague, Trainee post graduate in Department of Thoracic surgery , Ward 27
  • Misauq Mazcuri Jinnah Postgraduate Medical Centre , Karachi. Colleague, Trainee post graduate in Department of Thoracic surgery , Ward 27

Abstract

Background: Blunt Chest trauma (BCT) is caused by road traffic accidents (RTAs), falls, assaults, or occupational injuries. Age has been hypothesized to be a predictor of complications and adverse outcomes in the elderly. This study aimed to compare morbidity and mortality in young and elderly patients with BCT. Methods: This prospective two-arm study was conducted in Jinnah Postgraduate Medical Center, Karachi from July 1st till 31st December 2019 after approval from the Institutional review board. All hemodynamically stable patients with BCT presenting in the emergency were stratified in two groups. Group A included patients age 12-45 years; Group B were of age ‰¥65 years. Their clinical characteristics, complications, and in-hospital outcomes were compared. Data was analysed using SPSS version 16.0. Result: There were 39 (55.7%) patients in group A and 31 (44.3%) in group B. RTAs were a significant cause of BCT in Group A (p=0.01) and falls in Group B (p=0.003). Lacerations, open wound, and flail chest were significantly more common in Group A (p‰¤0.05). Complications of BCT including pneumonia and acute respiratory distress syndrome (ARDS) were significantly higher in Group B (p‰¤0.05). Group B required mechanical ventilation more often (45.2% vs. 12.8%; p=0.003). There were seven deaths in Group B (p=0.002) and none in Group A. Conclusion: Commonest cause of BCT in the elderly is falling. Similarly, the elderly are more prone to develop pneumonia, ARDS, and the need for ventilatory support. Early intervention to control pain, improve ventilation, and chest physiotherapy reduce the risk of morbidity and mortality.

Keywords: Blunt trauma; Blunt chest trauma; Age difference; Young; Elderly; Outcomes

Author Biography

Ambreen abid, Jinnah Postgraduate Medical Centre , Karachi. Trainee post graduate in Department of Thoracic surgery , Ward 27

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References

Lichtenstein DA, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, et al. Ultrasound diagnosis of occult pneumothorax. Crit. Care Med 2005;33(6):1231-8.

Edgecombe L, Sigmon DF, Galuska MA, Angus LD. Thoracic Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Update Nov 2018 [cited 2020 Apr]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK534843/

Saaiq M, Shah SA. Thoracic trauma: presentation and management outcome. J Coll Physicians Surg Pak 2008;18(4):230-3.

Bolandparvaz S, Yadollahi M, Abbasi H, Anvar M. Injury patterns among various age and gender groups of trauma patients in southern Iran. Medicine 2017;96(41):e7812.

Mollberg N, Tabachnick D, Lin F, Merlotti G, Varghese T, Arensman R. et al. Age-associated impact on presentation and outcome for penetrating thoracic trauma in the adult and pediatric patient populations. J Trauma Acute Care Surg 2014;76(2):273-8.

Demura S, Sato S, Yamaji S, Kasuga K, Nagasawa Y. Examination of validity of fall risk assessment items for screening high fall risk elderly among the healthy community-dwelling Japanese population. Arch Gerontol Geriatr 2011;53(1):e41-5.

Wiebe DJ, Ray S, Maswabi T, Kgathi C, Branas CC. Economic development and road traffic fatalities in two neighbouring African nations. Afr J Emerg Med 2016;6(2):80-6.

Yadollahi M, Arabi AH, Mahmoudi A, Zamani M, Farahmand M. Blunt Thoracic Injury Mortality and Clinical Presentation. Trauma Mon 2018;23(4):e13079.

Shi HH, Esquivel M, Staudenmayer KL, Spain DA. Effects of mechanism of injury and patient age on outcomes in geriatric rib fracture patients. Trauma Surg Acute Care Open 2017;2(1):e000074.

Curtis K, Asha SE, Unsworth A, Lam M, Goldsmith H, Langcake M, et al. ChIP: An early activation protocol for isolated blunt chest injury improves outcomes, a retrospective cohort study. Aust Emerg Nurs J 2016;19(3):127-32.

Battle CE, Hutchings H, James K, Evans PA. The risk factors for the development of complications during the recovery phase following blunt chest wall trauma: a retrospective study. Injury 2013;44(9):1171-6.

Huber S, Biberthaler P, Delhey P, Trentzsch H, Winter H, Van Griensven M, et al. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®). Scand J Trauma Resusc Emerg Med 2014;22(1):52.

Caragounis EC, Xiao Y, Granhed H. Mechanism of injury, injury patterns and associated injuries in patients operated for chest wall trauma. Eur J Trauma Emerg Surg. 2019;6:1-10.

Chima SA, Aminat FO, Abiodun PO, Nicholas KI, Zaccheus IA, Temitope AO. Plain X-ray findings among chest trauma patients in Lagos. West Afr J Radiol 2016;23(1):16.

Hanafi M, Al-Sarraf N, Sharaf H, Abdelaziz A. Pattern and presentation of blunt chest trauma among different age groups. Asian Cardiovasc Thorac Ann 2011;19(1):48-51.

El-Menyar A, Latifi R, AbdulRahman H, Zarour A, Tuma M, Parchani A, et al. Age and traumatic chest injury: a 3-year observational study. Eur J Trauma Emerg Surg 2013;39(4):397-403.

Subhani SS, Muzaffar MS, Siddiqui FR. Blunt thoracic trauma--an analysis of 264 patients in Rawalpindi, Pakistan. J Pak Med Assoc 2014;64(4):375-8.

Lotfipour S, Kaku SK, Vaca FE, Patel C, Anderson CL, Ahmed SS, et al. Factors associated with complications in older adults with isolated blunt chest trauma. West J Emerg Med 2009;10(2):79-84.

Söderlund T, Ikonen A, Pyhältö T, Handolin L. Factors associated with in-hospital outcomes in 594 consecutive patients suffering from severe blunt chest trauma. Scand J Surg 2015;104(2):115-20.

Sawa J, Green RS, Thoma B, Erdogan M, Davis PJ. Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review. Can J Emerg Med 2018;20(4):614-22.

Baram A, Kakamad FH. Bilateral thoracic trauma; presentation and management, a case series. Ann Med Surg 2019;43:25-8.

Ustundag M, Aldemir M, Orak M, Guloglu C. Predictors of Mortality in Blunt Multi-Trauma Patients: A Retrospective Review. Hong Kong J Emerg Med 2010;17(5):471-6.

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Published

2020-09-23

How to Cite

abid, A., Ahmad, T., Thapaliya, P., Dawani, S., Sikander, N., & Mazcuri, M. (2020). MORBIDITY AND MORTALITY AMONG PATIENTS SUSTAINING CHEST INJURY DUE TO BLUNT FORCE - THE DIFFERENCE BETWEEN YOUNG AND ELDERLY. Journal of Ayub Medical College Abbottabad, 32(4), 512–516. Retrieved from https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/7883

Issue

Vol. 32 No. 4 (2020): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

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ORIGINAL ARTICLE

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