The prognostic significance of thoracic and abdominal trauma in severe trauma patients


COD: 03_2010_171-176 Categorie: ,

Gianluca Costa, Federico Tomassini, Simone Maria Tierno, Luigi Venturini, Barbara Frezza, Giulio Cancrini, Francesco Stella

Ann. Ital. Chir., 2010; 81: 171-176

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The aim of the present study was to assess the prognostic significance of thoracic and abdominal trauma in severely
injured patients. A retrospective analysis was performed based on data from the period from March 1 2006 to December
31 2007, taken from the Trauma Registry of the University Hospital “Sant’Andrea” in Rome. A total of 844 trauma
patients were entered in a database created for this purpose, and only patients with an Injury Severity Score (ISS) >
15, (163 patients, 19.3%), were selected for the present study. These patients were divided into 2 groups: Group A (103
patients, 63.2%), consisting of patients with at least one thoracic injury, and Group B (46 patients, 28.2%) consisting
of patients with concomitant thoracic and abdominal injuries. The impact of thoracic and abdominal trauma was studied
by analyzing mortality and morbidity, in relation to patient age, cause and dynamics of trauma, length of hospital
stay, and both ISS and New ISS (NISS). In a vast majority of cases, the cause of trauma was a road accident (126
patients, 77.3%). The mean age of patients with ISS>15 was 45.2 ± 19.3 years. The mean ISS and NISS were 25.7
± 10.5 and of 31.4 ± 13.1 respectively. The overall morbidity and mortality rates were 18.4% (30 patients) and 28.8%
(47 patients) respectively. In Group A the mortality rate was 23.3% (24 patients) and the morbidity rate was 33.9%
(35 patients). In Group B mortality and morbidity rates were 36.9% (17 patients) and 43.5% (20 patients) respectively.
It was shown that the presence of both thoracic and abdominal injuries significantly increases the risk of mortality
and morbidity. In patients with predominantly thoracic injuries, NISS proved to be the more reliable score, while
ISS appeared to be more accurate in evaluating patients with injuries affecting more than one region of the body.