Blunt Minor Thoracic Trauma: A Prospective Analysis of 186 Patients in the Emergency Department

Yıl 2017, Yıl: 2017 Sayı: 3, 203 - 208, 01.12.2017

Faruk Güngör Kamil Can Akyol Taylan Kılıç Mustafa Keşaplı Asım Arı Ali Vefa Sayraç

https://doi.org/10.5505/kjms.2017.60352

Öz

Aim: There is limited information regarding patients with blunt
minor thoracic traumas (MTT) in terms of diagnosis, treatment,
emergency department (ED) management and follow-up after discharge.
The aim of this research, was to investigate demographics,
physical examination findings and their predictive value for concomitant
thoracic injuries, and outcomes of patients.
Material and Method: The mechanism of injury, physical examination
findings, radiographic findings, pain levels, discharge and
hospitalization diagnoses were recorded prospectively.
Results: A total of 186 patients with a mean age of 48±17 (18–
91) years were included in the study. 131 of the (70.4%) patients
were males. 171 of the patients (91.9%) were discharged, while 15
(8.1%) patients were hospitalized. The most common diagnosis
and physical finding were soft tissue trauma, and tenderness at
injury site (78.8%, 15.1%, 69.6%), respectively. The specificity of
physical findings in predicting concomitant thoracic injuries were
found to be 100%, although their sensitivities were too low. The
initial and 7th day pain levels of the patients with recurrent admissions
were significantly higher (p=0.019, p=0.025).
Conclusion: Most patients are discharged from ED without significant
morbidity and mortality. Patients exhibiting the positive physical
findings require detailed investigation for concomitant thoracic
injuries. As severe and long-lasting pains are determinants of hospital
re-admissions, it would be appropriate to provide adequate
analgesia and detailed information about the pain.

Anahtar Kelimeler

minor blunt thoracic trauma, physical examination, pain and analgesia

Künt Minör Toraks Travması: Acil Servise Başvuran 186 Hastanın Prospektif Analizi

Öz

Amaç: Künt minör toraks travmalı (MTT) hastalarda tanı, tedavi, acil servis (AS) yönetimi ve taburculuk sonrası takip bakımından
bilgiler kısıtlıdır. Hastaların demografik verilerini, fizik muayene bulgularını ve bu bulguların eşlik eden torasik yaralanmaları ön
görmedeki değerliklerini, hastaların sonlanımlarını araştırması amaçlandı.
Materyal ve Metot: Yaralanma mekanizması, fizik muayene bulguları, görüntüleme bulguları, ağrı düzeyleri, taburculuk ve hastaneye
yatış tanıları prospektif olarak çalışma formuna kaydedildi. 
Bulgular: Çalışmaya, alınan 186 hastanın yaş ortalaması 48±17 (18–91) 131’i (%70,4) erkekti. Hastaların 171’i (%91,9) acil servisten taburcu edilirken, 15’i (%8,1) hastaneye yatırıldı. En sık tanı, yumuşak doku travması (%78,8) ve en sık muayene bulgusu yaralanma yerinde duyarlılıktı (%69,6). Duyarlılıkları çok düşük olsa da fizik muayene bulguları eşlik eden torasik yaralanmaları saptamadaki özgüllükleri %100 bulundu. Tekrarlayan başvurusu olan hastaların başlangıç ve 7. gündeki ağrı düzeyleri istatistiki olarak daha yüksek saptandı (p=0,019, p=0,025).
Sonuç: MTT’lı çoğu hasta, önemli bir morbidite ve mortalite olmadan AS’den taburcu edilmektedir. Pozitif fizik muayene bulguları
bulunan hastalar, eşlik eden torasik yaralanmalar açısından detaylı araştırılmalıdır. Ciddi ve uzun süren ağrı tekrar başvuruların belirleyicileri olduğundan yeterli analjezik tedavi sağlanarak ağrı konusunda hastalar detaylı bilgilendirmelidir.

Anahtar Kelimeler

minör künt toraks travması, fizik muayene, ağrı ve analjezi

Kaynakça

• 1. Battistelle F, Benfield JR. Blunt and penetrating injuries of the chest wall, pleura and lungs. In: Shields TW, ed. General Thoracic Surgery 4th ed. USA. Williams and Wilkons Company; 2002:815–31.
• 2. Shweiki E, Klena J, Wood GC, Indeck M. Assessing the True Risk of Abdominal Solid Organ Injury in Hospitalized Rib Fracture Patients. J Trauma 2001;50(4):684–8.
• 3. Sırmali M, Türüt H, Topçu S, Gülhan E, Yazıcı U, Kaya S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg 2003;24(1):133–8.
• 4. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma 1994;37(6):975–9.
• 5. National Centre for Health Statistics. National hospital ambulatory medical care survey. Hyattsville, MD. Centres for Disease Control and Prevention Availablefrom: www. cdc. gov/ nchs/ahcd. htm; 2009 [accessed 05 05 14].
• 6. Kerr-Valentic MA, Arthur M, Mullins RJ, Pearson TE, Mayberry JC. Rib fracture pain and disability: can we do better? J Trauma 2003;54(6):1058–63.
• 7. Misthos P, Kakaris S, Sepsas E, Athanassiadi K, Skottis I. A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma. Eur J Cardiothorac Surg 2004;25(5):859–64.
• 8. Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A. Blunt thoracic trauma. Analysis of 515 patients. Ann Surg 1987;206:200–5.
• 9. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–96.
• 10. Demirhana R, Onana B, Oz K, Halezeroğlu S. Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interactive Cardiovascular and Thorac Surg 2009;9:450–3.
• 11. Karadayi S, Nadir A, Sahin E, Celik B, Arslan S, Kaptanoglu M. An analysis of 214 cases of rib fractures. Clinics 2011;66(3):449–51.
• 12. Gabram SG, Schwartz RJ, Jacobs LM, Lawrence D, Murphy MA, Morrow JS, et al. Clinical management of blunt trauma patients with unilateral rib fractures: a randomized trial. World J Surg 1995;19(3):388–93.
• 13. Lien YC, Chen CH, Lin HC. Risk Factors for 24-Hour Mortality After Traumatic Rib Fractures Owing to Motor Vehicle Accidents: A Nationwide Population-Based Study. Ann ThoracSurg 2009;88(4):1124–30.
• 14. Whitson BA, Mcgonigal MD, Andersonm CP, Dries DJ. Increasing Numbers of Rib Fractures Do Not Worsen Outcome: An Analysis of the National Trauma Data Bank. Am Surg 2013;79:140–50.
• 15. Plourde M, Emond M, Lavoie A, Guimont C, Le Sage N, Chauny JM, et al. Cohort study on the prevalence and risk factors for delayed pulmonary complications in adults following minor blunt thoracic trauma. CJEM 2014;16(2):136–43.
• 16. Fuhrman CR, Britton CA, Bender T, Sumkin JH, Brown ML, Holbert JM, et al. Observer performance studies: detection of single versus multiple abnormalitiesof the chest. AJR Am J Roentgenol 2002;179(6):1551–3.
• 17. Rainer TH, Griffith JF, Lam E, Lam PK, Metreweli C. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma 2004;56(6):1211–3.
• 18. Shields JF, Emond M, Guimont C, Pigeon D. Acute minor thoracic injuries: Evaluation of practice and follow-up in the emergency department. Can Fam Physician 2010;56:117–24.
• 19. Palas J, Matos AP, Mascarenhas V, Herédia V, Ramalho M. Multidetector computer tomography: evaluation of blunt chest trauma in adults. Radiol Res Pract 2014;864369.
• 20. Sharma OP, Hagler S, Oswanski MF. Prevalence of delayed hemothorax in blunt thoracic trauma. Am Surg 2005;71(6):481–6.