ABSTRACT
We reviewed 144 consecutive patients with flail chest and/or pulmonary contusion between 1979 and 1984. The purpose was to analyze the factors adversely affecting morbidity and mortality. There were 97 males and 47 females, with an average age of 40 years +/- 18 S.D. (range, 2-83). Seventy-five per cent of the injuries were caused by motor vehicle accidents, with the remainder due to falls (17%), cardiopulmonary resuscitation (4%), altercations (2%), or falling objects (2%). The Injury Severity Score (ISS) averaged 32 +/- 14 S.D. in all survivors versus 60 +/- 14 S.D. in those who died. Eighty-three patients (58%) required mechanical ventilation. Thirty-six patients died (25%). Isolated pulmonary contusion or flail chest had a mortality of 16% each. However, the mortality more than doubled when there was a combined pulmonary contusion and flail chest (42%). More than half of all deaths were directly attributed to central nervous system injuries with another third due to massive hemorrhage. Factors that were associated with a higher morbidity and mortality included severe associated thoracic injuries, a high ISS, the presence of shock, falls from heights, and the combination of pulmonary contusion and flail chest.
Subject(s)
Outcome and Process Assessment, Health Care , Thoracic Injuries/rehabilitation , Wounds, Nonpenetrating/rehabilitation , Adolescent , Adult , Aged , Child , Child, Preschool , Contusions/rehabilitation , Female , Flail Chest/rehabilitation , Humans , Lung Injury , Male , Middle Aged , Multiple Trauma/rehabilitation , Thoracic Injuries/complications , Thoracic Injuries/mortalityABSTRACT
Twenty-two trauma victims who had sustained flail chest as their only significant injury were evaluated to determine the final outcome. Fourteen patients (63.9 percent) were found to have long-term sequelae. The most common long-term problems after flail chest injury were persistent chest wall pain, chest wall deformity, and dyspnea on exertion. Five patients (22 percent) remained disabled in varying degrees.
Subject(s)
Disability Evaluation , Flail Chest/rehabilitation , Thoracic Injuries/rehabilitation , Adult , Aged , Dyspnea/etiology , Flail Chest/complications , Follow-Up Studies , Humans , Middle Aged , Outcome and Process Assessment, Health Care , Pain/etiology , Physical Exertion , Thoracic Diseases/etiology , ThoraxABSTRACT
A review of 62 consecutive patients who sustained flail chest after trauma from 1971 to 1982 was conducted to document the late effects of this injury. The mechanism of injury was motor vehicle accident in 44 (71%), fall in nine (14.5%), and farming accident in nine (14.5%). Patients ranged in age from 7 to 87 years. Twenty-four (39%) patients arrived in shock and 54 (87%) had major extra-thoracic associated injuries. Thirty-seven (60%) patients were managed by intubation and mechanical ventilation and 25 (40%) by chest physiotherapy. Pulmonary complications developed in 60% of the total group. Eight patients (12.9%) died during the initial hospitalization. Five patients died 1 month to 9 years after discharge, and 17 were eventually lost to followup. Six-month to 12-year followup (mean, 5 years) was re-established for 32 patients. Twenty-one of these returned for comprehensive testing including physical examination, chest roentgenograms, spirometry, flow volume curves, diffusion testing, and calculation of dyspnea index. Of 32 patients questioned, only 12 had returned to full-time employment. Eight (25%) still had subjective chest tightness, 15 (49%) complained of thoracic cage pain, and 12 (38%) had experienced moderate or severe change in their overall level of activity. Using the British Medical Research Gradation for Dyspnea, three (9%) patients had moderate and six (19%) severe shortness of breath. Objective dyspnea index calculated from VEBTPS /MVV revealed mild dyspnea in 50% and moderate dyspnea in 20%. Formal carbon monoxide diffusion testing was normal in 90% of patients and revealed mild decrease in 10%.(ABSTRACT TRUNCATED AT 250 WORDS)
