Predictors of Discharge Home after Blunt Traumatic Thoracic Aortic Injury.

BACKGROUND: Blunt traumatic thoracic aortic injury (BTAI) can be a highly lethal injury but in the last decade major advances have been made in diagnostic accuracy, injury grading, and therapy. Traditionally, emphasis has been on studying survival postinjury with a paucity of studies examining the discharge characteristics of patients that survive a BTAI. The purpose of this study is to define the epidemiology and predictors of disposition in patients with BTAI in a provincial database. METHODS: Using the Ontario Trauma Registry, all patients were identified who were hospitalized with a BTAI between 1999 and 2009. Trends in therapy and discharge disposition were determined. RESULTS: We identified 264 cases of BTAI. Of these, 157 were discharged from hospital with 36% (n = 56) going directly home and 64% (n = 101) going to continuing care facilities. There was no difference in disposition in those with BTAI treated operatively or nonoperatively (P = 0.48). In those that had repair of BTAI, there was no difference in discharge home between open and endovascular repair (P = 1.00). Univariate analyses identified younger age, male sex, lower injury severity score (ISS), and lower Charlson comorbidity indices as being predictors of discharge home. On adjusted multivariate regression analysis, lower ISS (odds ratio, 0.91; 95% confidence interval, 0.87-0.95; P < 0.001) was the only independent predictors of discharge home. CONCLUSIONS: Our findings suggest that the only independent predictor for discharge home for patients who survive is the overall severity of all their injuries irrespective of their condition on admission or management of their BTAI.

Risk Score for Predicting Mortality in Flail Chest.

BACKGROUND: Flail chest injuries are associated with high mortality and morbidity. Despite evidence that operative repair of flail chest is beneficial, it is rarely done. We sought to create a simple risk score using available preoperative covariates to calculate individual risk of mortality in flail chest. METHODS: A logistic regression model was trained on Ontario Trauma Registry data to generate a mortality risk score. The final model was validated for calibration and discrimination and corrected for optimism. RESULTS: The model uses five risk factors that are readily obtained during the initial assessment of the trauma patient: age, Glasgow Coma Score, ventilation, cardiopulmonary resuscitation, and number of comorbidities. It was determined that less than 6 points is consistent with 1% observed mortality, 6 to 10 points predicts 5% mortality, 11 to 15 points predicts 22% mortality, and 16 or more points predicts 46% mortality. CONCLUSIONS: We have developed a simple model that can be easily applied at bedside to predict mortality in patients with flail chest by accessing a spreadsheet program in an application or other handheld computer device. This model has the potential to be a useful tool for surgeons considering operative repair of flail chest.