Retrospective Analysis of the Clinical Outcome in a Matched Case-Control Cohort of Polytrauma Patients Following an Osteosynthetic Flail Chest Stabilization
Abstract
1. Introduction
2. Methods
3. Results
3.1. Demographic Data of the Study Cohort
3.2. Demographic Data of the Case-Control Matched Cohort
3.3. Outcome Analysis of the Case-Control Matched Cohort
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Jahresbericht 2019—TraumaRegister DGU®. Sektion Notfall- & Intensivmedizin & Schwerverletztenversorgung der Deutschen Gesellschaft für Unfallchirurgie e.V. 2019. Available online: http://www.traumaregister-dgu.de/fileadmin/user_upload/traumaregister-dgu.de/docs/Downloads/Jahresbericht_2019.pdf (accessed on 23 June 2020).
- Topp, T.; Müller, T.; Kiriazidis, I.; Lefering, R.; Ruchholtz, S. Trauma Registry of the German Trauma Society, et al. Multiple blunt trauma after suicidal attempt: An analysis of 4754 multiple severely injured patients. Eur. J. Trauma Emerg. Surg. 2012, 38, 19–24. [Google Scholar] [CrossRef] [PubMed]
- Reith, G.; Lefering, R.; Wafaisade, A.; Hensel, K.O.; Paffrath, T.; Bouillon, B.; Probst, C.; TraumaRegister DGU. Injury pattern, outcome and characteristics of severely injured pedestrian. Scand. J. Trauma Resusc. Emerg. Med. 2015, 23, 56. [Google Scholar] [CrossRef] [PubMed]
- Gennarelli, T.A.; Wodzin, E. AIS 2005: A contemporary injury scale. Injury 2006, 37, 1083–1091. [Google Scholar] [CrossRef]
- Kerr-Valentic, M.A.; Arthur, M.; Mullins, R.J.; Pearson, T.E.; Mayberry, J.C. Rib fracture pain and disability: Can we do better? J. Trauma Acute Care Surg. 2003, 54, 1058–1064. [Google Scholar] [CrossRef]
- Schulz-Drost, S.; Krinner, S.; Langenbach, A.; Oppel, P.; Lefering, R.; Taylor, D.; Hennig, F.F.; Mauerer, A.; TraumaRegister DGU. Concomitant Sternal Fracture in Flail Chest: An Analysis of 21,741 Polytrauma Patients from the TraumaRegister DGU®. Thorac. Cardiovasc. Surg. 2017, 65, 551–559. [Google Scholar]
- Coughlin, T.A.; Ng, J.W.G.; Rollins, K.E.; Forward, D.P.; Ollivere, B.J. Management of rib fractures in traumatic flail chest: A meta-analysis of randomised controlled trials. Bone Jt. J. 2016, 98, 1119–1125. [Google Scholar] [CrossRef]
- Tanaka, H.; Yukioka, T.; Yamaguti, Y.; Shimizu, S.; Goto, H.; Matsuda, H.; Shimazaki, S. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J. Trauma 2002, 52, 727–732. [Google Scholar] [CrossRef]
- Granetzny, A.; Abd El-Aal, M.; Emam, E.; Shalaby, A.; Boseila, A. Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status. Interact. Cardiovasc. Thorac. Surg. 2005, 4, 583–587. [Google Scholar] [CrossRef]
- Marasco, S.F.; Davies, A.R.; Cooper, J.; Varma, D.; Bennett, V.; Nevill, R.; Lee, G.; Bailey, M.; Fitzgerald, M. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J. Am. Coll. Surg. 2013, 216, 924–932. [Google Scholar] [CrossRef] [PubMed]
- Baker, S.P.; O’Neill, B.; Haddon, W.; Long, W.B. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J. Trauma 1974, 14, 187–196. [Google Scholar] [CrossRef] [PubMed]
- Paffrath, T.; Lefering, R.; Flohé, S.; TraumaRegister DGU. How to define severely injured patients?—An Injury Severity Score (ISS) based approach alone is not sufficient. Injury 2014, 45, S64–S69. [Google Scholar] [CrossRef] [PubMed]
- Pape, H.-C.; Lefering, R.; Butcher, N.; Peitzman, A.; Leenen, L.; Marzi, I.; Lichte, P.; Josten, C.; Bouillon, B.; Schmucker, U.; et al. The definition of polytrauma revisited: An international consensus process and proposal of the new “Berlin definition”. J. Trauma Acute Care Surg. 2014, 77, 780–786. [Google Scholar] [CrossRef] [PubMed]
- Hess, D.R. Respiratory Mechanics in Mechanically Ventilated Patients. Respir. Care 2014, 59, 1773–1794. [Google Scholar] [CrossRef] [PubMed]
- Granhed, H.P.; Pazooki, D. A Feasibility Study of 60 Consecutive Patients Operated for Unstable Thoracic Cage. J. Trauma Manag. Outcomes 2014, 8, 20. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311414/ (accessed on 24 June 2020). [CrossRef] [PubMed]
- Holcomb, J.B.; McMullin, N.R.; Kozar, R.A.; Lygas, M.H.; Moore, F.A. Morbidity from rib fractures increases after age 45. J. Am. Coll Surg. 2003, 196, 549–555. [Google Scholar] [CrossRef]
- Farquhar, J.; Almarhabi, Y.; Slobogean, G.; Slobogean, B.; Garraway, N.; Simons, R.K.; Hameed, S.M. No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: Results of a retrospective cohort study. Can. J. Surg. 2016, 59, 299–303. [Google Scholar] [CrossRef] [PubMed]
- Caragounis, E.-C.; Fagevik Olsén, M.; Pazooki, D.; Granhed, H. Surgical treatment of multiple rib fractures and flail chest in trauma: A one-year follow-up study. World J. Emerg. Surg. 2016, 11, 1–7. [Google Scholar] [CrossRef]
- Olsén, M.F.; Slobo, M.; Klarin, L.; Caragounis, E.-C.; Pazooki, D.; Granhed, H. Physical function and pain after surgical or conservative management of multiple rib fractures—A follow-up study. Scand. J. Trauma Resusc. Emerg. Med. 2016, 24, 128. [Google Scholar] [CrossRef]
- Bemelman, M.; De Kruijf, M.W.; Van Baal, M.; Leenen, L. Rib Fractures: To Fix or Not to Fix? An Evidence-Based Algorithm. Korean J. Thorac. Cardiovasc. Surg. 2017, 50, 229–234. [Google Scholar] [CrossRef]
- Papurica, M.; Rogobete, A.F.; Sandesc, D.; Dumache, R.; Cradigati, C.A.; Sarandan, M.; Nartita, R.; Popovici, S.E.; Bedreag, O.H. Advances in Biomarkers in Critical Ill Polytrauma Patients. Clin. Lab. 2016, 62, 977–986. [Google Scholar] [CrossRef]
- Ciriello, V.; Gudipati, S.; Stavrou, P.Z.; Kanakaris, N.K.; Bellamy, M.C.; Giannoudis, P.V. Biomarkers predicting sepsis in polytrauma patients: Current evidence. Injury 2013, 44, 1680–1692. [Google Scholar] [CrossRef] [PubMed]
- Reinke, S.; Geissler, S.; Taylor, W.R.; Schmidt-Bleek, K.; Juelke, K.; Schwachmeyer, V.; Dahne, M.; Hartwig, T.; Akyüz, L.; Meisel, C.; et al. Terminally differentiated CD8+ T cells negatively affect bone regeneration in humans. Sci. Transl. Med. 2013, 5, 177ra36. [Google Scholar] [CrossRef] [PubMed]
- Sass, F.A.; Schmidt-Bleek, K.; Ellinghaus, A.; Filter, S.; Rose, A.; Preininger, B.; Reinke, S.; Geissler, S.; Volk, H.; Duda, G.N.; et al. CD31+ Cells From Peripheral Blood Facilitate Bone Regeneration in Biologically Impaired Conditions Through Combined Effects on Immunomodulation and Angiogenesis. J. Bone Miner. Res. 2017, 32, 902–912. [Google Scholar] [CrossRef] [PubMed]
- Schlundt, C.; Reinke, S.; Geissler, S.; Bucher, C.H.; Giannini, C.; Märdian, S.; Dahne, M.; Kleber, C.; Samans, B.; Baronet, U.; et al. Individual Effector/Regulator T Cell Ratios Impact Bone Regeneration. Front. Immunol. 2019, 10, 1954. [Google Scholar] [CrossRef]
Total Sample (N = 70) | Conservative Treatment (N = 59) | Operative Treatment (N = 11) | |
---|---|---|---|
sex (female/male) | 17/53 | 17/42 | 0/11 |
age [years] | 50.69 ± 16.18 (range 16–82) | 51.46 ± 16.25 (range 16–81) | 46.55 ± 15.85 (range 29–82) |
ISS | 33.24 ± 12.17 (range 16.0–75.0) | 33.97 ± 12.07 (range 16–75) | 29.36 ± 12.55 (range 16–57) |
Flail chest (unilateral/bilateral) | 50/20 | 48/11 | 2/9 |
Pneumonia (no/yes) | 39/31 | 34/25 | 5/6 |
Morphine equivalent dosage [mg p. o.] | 100.65 ± 236.95 (range 0–1200.0) | 111.0 ± 253.87 (range 0–1200.0) | 39.67 ± 65.65 (range 0–180.0) |
Hospital treatment [days] | 23.90 ± 13.69 (range 1.0–68.0) | 22.85 ± 13.63 (range 1.0–68.0) | 30.10 ± 13.01 (range 12.0–54.0) |
Intensive care unit treatment [days] | 17.91 ± 14.59 (range 1.0–68.0) | 16.56 ± 14.33 (range 1.0–68.0) | 25.18 ± 14.48 (range 5.0–48.0) |
Normal ward treatment [days] | 6.28 ± 7.61 (range 0–35.0) | 6.29 ± 7.91 (range 0–35.0) | 6.20 ± 5.85 (range 0–15.0) |
Invasive ventilation [days] | 7.93 ± 9.10 (range 0–42.0) | 8.17 ± 9.85 (range 0–42.0) | 7.10 ± 6.14 (range 0–19.0) |
Conservative Treatment (N = 11) | Operative Treatment (N = 11) | |
---|---|---|
sex (female/male) | 3/8 | 0/11 |
age [years] | 46.18 ± 13.78 (range 25–77) | 46.55 ± 15.85 (range 29–82) |
ISS | 29.27 ± 11.58 (range 20–57) | 29.36 ± 12.55 (range 16–57) |
Flail chest (unilateral/bilateral) | 11/0 | 2/9 |
Pneumonia (no/yes) | 7/4 | 5/6 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Niemann, M.; Graef, F.; Tsitsilonis, S.; Stöckle, U.; Märdian, S. Retrospective Analysis of the Clinical Outcome in a Matched Case-Control Cohort of Polytrauma Patients Following an Osteosynthetic Flail Chest Stabilization. J. Clin. Med. 2020, 9, 2379. https://doi.org/10.3390/jcm9082379
Niemann M, Graef F, Tsitsilonis S, Stöckle U, Märdian S. Retrospective Analysis of the Clinical Outcome in a Matched Case-Control Cohort of Polytrauma Patients Following an Osteosynthetic Flail Chest Stabilization. Journal of Clinical Medicine. 2020; 9(8):2379. https://doi.org/10.3390/jcm9082379
Chicago/Turabian StyleNiemann, Marcel, Frank Graef, Serafeim Tsitsilonis, Ulrich Stöckle, and Sven Märdian. 2020. "Retrospective Analysis of the Clinical Outcome in a Matched Case-Control Cohort of Polytrauma Patients Following an Osteosynthetic Flail Chest Stabilization" Journal of Clinical Medicine 9, no. 8: 2379. https://doi.org/10.3390/jcm9082379
APA StyleNiemann, M., Graef, F., Tsitsilonis, S., Stöckle, U., & Märdian, S. (2020). Retrospective Analysis of the Clinical Outcome in a Matched Case-Control Cohort of Polytrauma Patients Following an Osteosynthetic Flail Chest Stabilization. Journal of Clinical Medicine, 9(8), 2379. https://doi.org/10.3390/jcm9082379