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首页> 美国卫生研究院文献>International Journal of Burns and Trauma >Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung head and abdominal injuries
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Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung head and abdominal injuries

机译：创伤患者的不良预后与肋骨骨折的负担以及肺头部和腹部损伤的严重程度独立相关

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Objective: We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Subjects and methods: Consecutive admissions to a trauma center with Injury Severity Score ≥ 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ≤ 20% = 1, ≤ 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Results: Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p < 0.001), hemo/pneumothorax (p < 0.001), lung infiltrates (p < 0.001), thoracic spine injuries (p = 0.001), sternal fractures (p = 0.0028) and death or need for mechanical ventilation ≥ 3 days (Death/Vdays ≥ 3) (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p < 0.001), LIS (p < 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Of the 193 rib fracture patients, Glasgow Coma Score 3-12 or head AIS ≥ 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ≥ 3 occurred in 31%. Death/Vdays ≥ 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ≥ 13 (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p = 0.02), LIS (p = 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Death/Vdays ≥ 3 association was better for RCFS (p = 0.005) than rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Conclusion: Rib fracture patients have increased risk for truncal injuries and adverse outcomes. Adverse outcomes are independently associated with rib cage fracture burden. Severity of head, abdominal, and lung injuries also influence rib fracture outcomes.
机译：目的：我们假设肺损伤和胸廓骨折量化可能与不良预后相关。受试者和方法：连续进入创伤严重程度得分≥9、18-75岁且钝器受伤的创伤中心。回顾CT扫描以评分肋骨和胸骨骨折以及肺浸润。胸骨和每个前，外侧和后肋骨骨折的评分为1 =未移位，2 =移位。肋骨骨折评分（RCFS）=肋骨骨折总评分+胸骨骨折评分+胸椎简短损伤评分（AIS）。对四个肺区域（右上/中，右下，左上和左下叶）分别计入浸润百分比：0％= 0； ≤20％= 1，≤50％= 2，> 50％= 3；总共4分=肺浸润得分（LIS）。结果：在599例患者中，有193例（32％）有854处肋骨骨折。肋骨骨折患者有更多的腹部损伤（p <0.001），血液/气胸（p <0.001），肺浸润（p <0.001），胸椎损伤（p = 0.001），胸骨骨折（p = 0.0028）和死亡或需要机械通气≥3天（Death / Vdays≥3）（p <0.001）。死亡/ Vday≥3与RCFS（p <0.001），LIS（p <0.001），头部AIS（p <0.001）和腹部AIS（p <0.001）独立相关。在193例肋骨骨折患者中，有43％发生格拉斯哥昏迷评分3-12或头部AIS≥2。 55％的患者发生了肺浸润或血液/气胸。胸椎损伤发生率为23％。 RCFS为6.3±4.4，而有3％的死亡/死亡天数≥3。死亡率/ Vday≥3的比率与RCFS值相关：1-3的19％； 4-6分时为24％； 7-12岁时42％，≥13岁时65％（p <0.001）。死亡/ Vday≥3与RCFS（p = 0.02），LIS（p = 0.001），头部AIS（ p <0.001）和腹部AIS（ p < 0.001）。 RCFS的死亡/ Vday≥3关联（ p = 0.005）优于肋骨骨折评分（ p = 0.08）或肋骨断裂数目（ p = 0.80）。 结论：肋骨骨折患者发生截断伤和不良后果的风险增加。不良预后与肋骨骨折的负担独立相关。头部，腹部和肺部的严重损伤也影响肋骨骨折的预后。

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