In-Hospital Predictors of Need for Ventilatory Support and Mortality in Chest Trauma: A Multicenter Retrospective Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Niguarda Hospital (Milan) (n = 832) | Maggiore Hospital (Novara) (n = 248) | Total Patients (n = 1080) | p-Value | |
---|---|---|---|---|
Male [n (%)] | 653 (78.49) | 192 (77.42) | 845 (78.24) | 0.7210 |
Age overall [median (IQR)] | 49 [38–62] | 53.15 [36–67] | 38 (63–87) | |
Age [n (%)] | 0.0002 | |||
<65 years old | 651 (78.25) | 164 (66.13) | 815 (75.46) | |
ears old | 95 (11.42) | 51 (20.56) | 146 (13.52) | |
>75 years old | 86 (10.34) | 33 (13.31) | 119 (11.02) | |
Median GCS in ED [median (IQR)] | 15 [3–15] | 15 [15–15] | 15 [11–15] | <0.0001 |
Median SpO2 in ED [median (IQR)] | 99 [96–100] | 96 [93–99] | 98 [96–100] | <0.0001 |
ASA score [n (%)] | 0.0092 | |||
I | 508 (61.13) | 127 (51.42) | 635 (58.91) | |
II | 266 (32.01) | 93 (37.65) | 359 (33.30) | |
III | 55 (6.62) | 24 (9.72) | 79 (7.33) | |
IV | 2 (0.24) | 3 (1.21) | 5 (0.46) | |
Mechanism [n (%)] | <0.0001 | |||
Car | 161 (20.10) | 79 (31.89) | 240 (22.90) | |
Motorcycle | 256 (31.96) | 57 (23.08) | 313 (29.87) | |
Pedestrian struck | 121 (15.11) | 21 (8.50) | 142 (13.55) | |
Fall | 189 (23.60) | 72 (29.15) | 261 (24.90) | |
Cyclist | 57 (7.12) | 18 (7.29) | 75 (7.16) | |
Other | 17 (2.12) | 0 | 17 (1.62) | |
TI [n (%)] | 336 (40.38) | 66 (22.61) | 402 (37.22) | <0.0001 |
TI reason [n (%)] * | <0.0001 | |||
GCS < 8 | 246 (73.21) | 15 (23.08) | 261 (65.09) | |
Surgery | 34 (10.12) | 28 (43.08) | 62 (15.46) | |
Hemodynamic instability | 13 (3.87) | 7 (10.77) | 20 (4.99) | |
Respiratory failure | 20 (5.95) | 10 (15.38) | 30 (7.48) | |
Airway obstruction | 6 (1.79) | 2 (3.08) | 8 (2.00) | |
Agitation | 17 (5.06) | 3 (4.62) | 20 (4.99) | |
E-FAST [n (%)] | 810 (97.36) | 58 (23.48) | 868 (80.44) | <0.0001 |
Chest X-ray [n (%)] | 691 (83.05) | 69 (27.94) | 760 (70.44) | <0.0001 |
Torso CT [n (%)] | 732 (87.98) | 216 (87.45) | 948 (87.86) | 0.8223 |
Emergency Surgery [n (%)] | 313 (37.62) | 31 (12.55) | 344 (31.88) | <0.0001 |
Chest AIS’98 [n (%)] | <0.0001 | |||
<3 | 145 (17.43) | 82 (33.07) | 227 (21.02) | |
≥3 | 687 (82.57) | 166 (66.94) | 853 (78.98) | |
Abdomen AIS’98 [n (%)] | 0.0523 | |||
<3 | 677 (81.37) | 215 (86.69) | 892 (82.59) | |
≥3 | 155 (18.63) | 33 (13.31) | 188 (17.41) | |
Head AIS’98 [n (%)] | ≤0.0001 | |||
<3 | 559 (67.27) | 209 (84.27) | 768 (71.18) | |
≥3 | 272 (32.73) | 39 (15.73) | 311 (28.82) | |
Extremity AIS’98 [n (%)] | ≤0.0001 | |||
<3 | 577 (69.35) | 209 (84.27) | 786 (72.78) | |
≥3 | 255 (30.65) | 39 (15.73) | 294 (27.22) | |
Median ISS [median (IQR)] | 24 [14–36] | 14 [10–22] | 21 [13–33] | <0.0001 |
RTS [median (IQR)] | 12 [4–12] | 12 [12–12] | 12 [10–12] | <0.0001 |
Death probability TRISS [median (IQR)] | 4.80 [1.60–18.70] | 1.98 [0.53–4.63] | 3.78 [1.10–15.10] | <0.0001 |
Deceased [n (%)] | 77 (9.25) | 20 (8.10) | 97 (8.99) | 0.5765 |
Multivariate Model | |||||
---|---|---|---|---|---|
No-TI (n = 678) | TI (n = 402) | p-Value | OR [95% CI] | p-Value | |
Center [n (%)] | <0.0001 | 0.5365 | |||
Niguarda Hospital (Milan) | 496 (73.16) | 336 (85.58) | 0.86 [0.54–1.38] | ||
Maggiore Hospital (Novara) | 182 (26.84) | 66 (16.42) | Ref | ||
Male [n (%)] | 529 (78.02) | 316 (78.61) | 0.8223 | 1.11 [0.71–1.74] | 0.6435 |
Age [n (%)] | 0.4782 | 0.3983 | |||
<65 years old | 504 (74.34) | 311 (77.36) | Ref | ||
65–75 years old | 94 (13.86) | 52 (12.94) | 1.43 [0.85–2.40] | ||
>75 years old | 80 (11.80) | 39 (9.70) | 1.08 [0.62–1.91] | ||
Median GCS in ED [median (IQR)] | 15 [15–15] | 3 [3–14] | <0.0001 | ||
Median SpO2 in ED [median (IQR) | 98 [96–100] | 99 [95–100] | 0.0904 | ||
ASA score [n (%)] | 0.6684 | ||||
I | 391 (57.75) | 244 (60.85) | |||
II | 232 (34.27) | 127 (31.67) | |||
III | 50 (7.39) | 29 (7.23) | |||
IV | 4 (0.59) | 1 (0.25) | |||
Mechanism [n (%)] | 0.0015 | ||||
Car | 168 (25.49) | 72 (18.51) | |||
Motorcycle | 205 (31.11) | 108 (27.76) | |||
Pedestrian struck | 83 (12.59) | 59 (15.17) | |||
Fall | 139 (21.09) | 122 (31.36) | |||
Cyclist | 53 (8.04) | 22 (5.66) | |||
Other | 11 (1.67) | 6 (1.54) | |||
Emergency Surgery [n (%)] | 100 (14.75) | 244 (60.85) | <0.0001 | ||
Chest AIS’98 [n (%)] | <0.0001 | ||||
<3 | 189 (27.88) | 38 (9.45) | |||
≥3 | 489 (72.12) | 364 (90.55) | |||
Abdomen AIS’98 [n (%)] | <0.0001 | ||||
< 3 | 605 (89.23) | 287 (71.39) | |||
≥ 3 | 73 (10.77) | 115 (28.61) | |||
Head AIS’98 [n (%)] | <0.0001 | ||||
<3 | 587 (86.58) | 181 (45.14) | |||
≥3 | 91 (13.42) | 220 (54.86) | |||
Extremity AIS’98 [n (%)] | <0.0001 | ||||
<3 | 553 (81.56) | 233 (57.96) | |||
≥3 | 125 (18.44) | 169 (42.04) | |||
1st and/or 2nd rib fractures [n (%)] | 200 (29.59) | 183 (46.10) | |||
N rib fractures [n (%)] | <0.0001 | 0.0001 | |||
0 | 39 (5.92) | 8 (2.07) | Ref | ||
1–3 | 308 (46.74) | 125 (32.30) | 2.51 [0.81–7.72] | ||
4–8 | 264 (40.06) | 168 (43.41) | 3.74 [1.24–11.31] | ||
>9 | 48 (7.28) | 86 (22.22) | 8.58 [2.57–28.57] | ||
Bilateral rib fractures [n (%)] | 108 (15.93) | 129 (32.17) | <0.0001 | ||
Scapula/clavicle/sternum fractures [n (%)] | 121 (17.85) | 95 (23.63) | 0.0216 | 1.57 [1.01–2.46] | 0.0458 |
Pneumothorax [n (%)] | 236 (34.81) | 188 (46.88) | <0.0001 | ||
Hemothorax [n (%)] | 24 (3.54) | 40 (9.98) | <0.0001 | 3.42 [1.50–7.78] | 0.0035 |
Pulmonary contusion [n (%)] | 267 (39.38) | 259 (64.59) | <0.0001 | 1.55 [1.06–2.56] | 0.0241 |
Pleural effusion [n (%)] | 104 (15.34) | 96 (23.94) | 0.0004 | ||
Median ISS in ED [median (IQR)] | 16 [10–22] | 34 [25–42] | <0.0001 | 1.08 [1.06–1.10] | <0.0001 |
RTS [median (IQR)] | 12 [12–12] | 4 [4–12] | <0.0001 | ||
Chest Tube Thoracostomy [n (%)] | 100 (14.75) | 244 (60.85) | <0.0001 | ||
Death probability TRISS [median (IQR)] | 2.03 [0.80–4.99] | 15.30 [4.26–55.30] | <0.0001 |
Multivariate Model | |||||
---|---|---|---|---|---|
No NIMV (n = 546) | NIMV (n = 110) | p-Value | OR [95% CI] | p-Value | |
Center | 0.0227 | 0.1500 | |||
Niguarda Hospital (Milan) | 389 (71.25) | 90 (81.82) | 1.64 [0.84–3.21] | ||
Novara Hospital (Novara) | 157 (28.75) | 20 (18.18) | ref | ||
Male [n (%)] | 422 (77.29) | 92 (83.64) | 0.1403 | 1.39 [0.75–2.59] | 0.2945 |
Age [mean (±SD)] | 0.2014 | 0.0487 | |||
<65 years old | 416 (76.19) | 75 (68.18) | Ref | ||
65–75 years old | 71 (13.00) | 20 (18.18) | 2.10 [1.12–3.96] | ||
>75 years old | 59 (10.81) | 15 (1364) | 1.63 [0.80–3.32] | ||
Median GCS in ED [median (IQR)] | 15 (15–15) | 15 (15–15) | 0.1084 | ||
Median SpO2 [median (IQR)] | 98 [96–100] | 98 [96–100] | 0.4051 | ||
ASA score [n (%)] | 0.3033 | ||||
I | 327 (60.00) | 57 (51.82) | |||
II | 178 (32.66) | 44 (40.00) | |||
III | 36 (6.61) | 9 (8.18) | |||
IV | 4 (0.73) | 0 (0.00) | |||
Mechanism [n (%)] | 0.1257 | ||||
Car | 138 (25.699) | 27 (25.33) | |||
Motorcycle | 166 (31.26) | 36 (33.64) | |||
Pedestrian struck | 70 (13.18) | 8 (7.48) | |||
Fall | 108 (20.34) | 22 (20.56) | |||
Cyclist | 38 (7.16) | 14 (13.08) | |||
Other | 11 (2.07) | 0 (0.00) | |||
Emergency Surgery [n (%)] | 76 (13.92) | 20 (18.18) | 0.2485 | ||
Chest AIS’98 [n (%)] | ≤0.0001 | ||||
<3 | 177 (32.42) | 9 (8.18) | |||
≥3 | 369 (67.58) | 101 (91.82) | |||
Abdomen AIS’98 [n (%)] | 0.7392 | ||||
<3 | 487 (89.19) | 97 (88.18) | |||
≥3 | 59 (10.81) | 13 (11.82) | |||
Head AIS’98 [n (%)] | 0.0079 | ||||
<3 | 483 (88.46) | 87 (79.09) | |||
≥3 | 63 (11.54) | 23 (20.91) | |||
Extremity AIS’98 [n (%)] | 0.2725 | ||||
<3 | 451 (82.60) | 86 (78.18) | |||
≥3 | 95 (17.40) | 24 (21.82) | |||
1st and/or 2nd rib fractures [n (%)] | 144 (26.37) | 49 (45.37) | <0.0001 | ||
N rib fractures [n (%)] | <.0001 | 0.0009 | |||
0 | 36 (6.79) | 2 (1.87) | Ref | ||
1–3 | 266 (50.19) | 33 (30.84) | 1.72 [0.34–8.76] | ||
4–8 | 205 (38.68) | 51 (47.66) | 2.81 [0.57–13.88] | ||
>9 | 23 (4.34) | 21 (19.63) | 7.65 [1.43–41.02] | ||
Bilateral rib fractures [n (%)] | 73 (13.37) | 29 (26.36) | 0.0006 | ||
Scapula/clavicle/sternum fractures [n (%)] | 93 (17.03) | 25 (22.73) | 0.1560 | ||
Pneumothorax [n (%)] | 176 (32. 23) | 54 (49.09) | 0.0007 | ||
Hemothorax [n (%)] | 13 (2.38) | 10 (9.09) | 0.0005 | 4.45 [1.68–11.76] | 0.0027 |
Pulmonary contusion [n (%)] | 197 (36.08) | 63 (57.27) | <0.0001 | 1.83 [1.12–3.00] | 0.0160 |
Pleural effusion [n (%)] | 75 (13.74) | 25 (22.73) | <0.0001 | ||
ISS [median (IQR)] | 14 [10–20] | 22 [14–29] | <0.0001 | 1.05 [1.02–1.07] | 0.0001 |
RTS [median (IQR)] | 12 [12–12] | 12 [12–12] | 0.0874 | ||
Chest Tube Thoracostomy [n (%)] | 48 (8.79) | 29 (26.36) | <0.0001 | ||
Death probability TRISS [median (IQR)] | 1.60 (0.70–4.50) | 4.50 (1.70–10.50) | <0.0001 |
Multivariate Model | |||||
---|---|---|---|---|---|
Survived (n = 982) | Deceased (n = 97) | p-Value | OR [95% CI] | p-Value | |
Center | 0.5765 | 0.40 [0.18–0.91] | 0.0279 | ||
Niguarda Hospital (Milan) | 755 (76.88) | 77(79.38) | |||
Novara Hospital (Novara) | 227 (23.12) | 20 (20.62) | |||
Male [n (%)] | 772 (78.62) | 72 (74.23) | 0.3178 | 1.11 [0.58–2.14] | 0.7558 |
Age [n (%)] | <0.0001 | <0.0001 | |||
<65 years old | 765 (77.90) | 49 (50.52) | Ref | ||
65–75 years old | 128 (13.03) | 18 (18.56) | 3.27 [1.49–7.20] | ||
>75 years old | 89 (9.06) | 30 (30.93) | 13.28 [6.43–27.45] | ||
Median GCS in ED [median (IQR)] | 15 [14–15] | 3 [3–13] | <0.0001 | ||
Median SpO2 in ED [median (IQR) | 98 (96–100) | 97 (90–100) | 0.0226 | 0.93 [0.89–0.97] | 0.0010 |
ASA score [n (%)] | 0.0058 | ||||
I | 591 (60.24) | 44 (45.36) | |||
II | 321 (32.72) | 38 (39.18) | |||
III | 65 (6.63) | 14 (14.43) | |||
IV | 4 (0.41) | 1 (1.03) | |||
Mechanism [n (%)] | 0.0210 | ||||
Car | 223 (23.40) | 17 (17.89) | |||
Motorcycle | 295 (30.95) | 18 (18.95) | |||
Pedestrian struck | 128 (13.43) | 14 (14.74) | |||
Fall | 226 (23.71) | 35 (36.84) | |||
Cyclist | 65 (6.82) | 10 (10.53) | |||
Other | 16 (1.98) | 1 (1.05) | |||
Emergency Surgery [n (%)] | 292 (29.74) | 52 (53.61) | <0.0001 | ||
Chest AIS’98 [n (%)] | 0.0013 | ||||
<3 | 218 (22.20) | 8 (8.25) | |||
≥3 | 764 (77.80) | 89 (91.75) | |||
Abdomen AIS’98 [n (%)] | 0.0007 | ||||
<3 | 823 (83.81) | 68 (70.10) | |||
≥3 | 159 (16.19) | 29 (29.90) | |||
Head AIS’98 [n (%)] | <0.0001 | ||||
<3 | 743 (75.66) | 25 (26.04) | |||
≥3 | 239 (24.34) | 71 (73.96) | |||
Extremity AIS’98 [n (%)] | 0.0027 | ||||
<3 | 727 (74.03) | 58 (59.79) | |||
≥3 | 255 (25.97) | 39 (40.21) | |||
1st and/or 2nd rib fractures [n (%)] | 340 (34.76) | 43 (45.26) | 0.0414 | ||
N rib fractures [n (%)] | 0.0050 | ||||
0 | 43 (4.50) | 4 (4.40) | |||
1–3 | 409 (42.83) | 24 (26.37) | |||
4–8 | 389 (40.73) | 43 (47.25) | |||
>9 | 114 (11.94) | 20 (21.98) | |||
Bilateral rib fractures [n (%)] | 198 (20.16) | 39 (40.21) | <0.0001 | ||
Scapula/clavicle/sternum fractures [n (%)] | 196 (19.96) | 20 (20.62) | 0.8770 | ||
Pneumothorax [n (%)] | 383 (39.00) | 41 (42.27) | 0.5298 | ||
Hemothorax [n (%)] | 51 (5.19) | 13 (13.40) | 0.0011 | ||
Pulmonary contusion [n (%)] | 468 (47.66) | 58 (59.79) | 0.0225 | ||
Pleural effusion [n (%)] | 176 (17.92) | 24 (24.74) | 0.0992 | ||
ISS [median (IQR)] | 19 (13–29) | 41 (34–54) | <0.0001 | 1.08 [0.105–1.10] | <0.0001 |
RTS [median (IQR)] | 12 (12–12) | 4 (3–11) | <0.0001 | 0.79 [0.73–0.86] | <0.0001 |
Chest Tube Thoracostomy [n (%)] | 193 (19.65) | 37 (38.14) | <0.0001 | ||
Death probability TRISS [median (IQR)] | 3.20 (1.10–10.25) | 77.80 (27.40 96.40) | <0.0001 |
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Reitano, E.; Gavelli, F.; Iannantuoni, G.; Fattori, S.; Airoldi, C.; Matranga, S.; Cioffi, S.P.B.; Ingala, S.; Virdis, F.; Rizzo, M.; et al. In-Hospital Predictors of Need for Ventilatory Support and Mortality in Chest Trauma: A Multicenter Retrospective Study. J. Clin. Med. 2023, 12, 714. https://doi.org/10.3390/jcm12020714
Reitano E, Gavelli F, Iannantuoni G, Fattori S, Airoldi C, Matranga S, Cioffi SPB, Ingala S, Virdis F, Rizzo M, et al. In-Hospital Predictors of Need for Ventilatory Support and Mortality in Chest Trauma: A Multicenter Retrospective Study. Journal of Clinical Medicine. 2023; 12(2):714. https://doi.org/10.3390/jcm12020714
Chicago/Turabian StyleReitano, Elisa, Francesco Gavelli, Giacomo Iannantuoni, Silvia Fattori, Chiara Airoldi, Simone Matranga, Stefano Piero Bernardo Cioffi, Silvia Ingala, Francesco Virdis, Martina Rizzo, and et al. 2023. "In-Hospital Predictors of Need for Ventilatory Support and Mortality in Chest Trauma: A Multicenter Retrospective Study" Journal of Clinical Medicine 12, no. 2: 714. https://doi.org/10.3390/jcm12020714