Road traffic accident-related thoracic trauma: Epidemiology, injury pattern, outcome, and impact on mortality-A multicenter observational study

Abstract

Background: Thoracic trauma is a major cause of death in trauma patients and road traffic accident (RTA)-related thoracic injuries have different characteristics than those with non-RTA related thoracic traumas, but this have been poorly described. The main objective was to investigate the epidemiology, injury pattern and outcome of patients suffering a significant RTA-related thoracic injury. Secondary objective was to investigate the influence of serious thoracic injuries on mortality, compared to other serious injuries.

Methods: We performed a multicenter observational study including patients of the Rhône RTA registry between 1997 and 2016 sustaining a moderate to lethal (Abbreviated Injury Scale, AIS≥2) injury in any body region. A subgroup (AISThorax≥2 group) included those with one or more AIS≥2 thoracic injury. Descriptive statistics were performed for the main outcome and a multivariate logistic regression was computed for our secondary outcome.

Results: A total of 176,346 patients were included in the registry and 6,382 (3.6%) sustained a thoracic injury. Among those, median age [IQR] was 41 [25-58] years, and 68.9% were male. The highest incidence of thoracic injuries in female patients was in the 70-79 years age group, while this was observed in the 20-29 years age group among males. Most patients were car occupants (52.3%). Chest wall injuries were the most frequent thoracic injuries (62.1%), 52.4% of which were multiple rib fractures. Trauma brain injuries (TBI) were the most frequent concomitant injuries (29.1%). The frequency of MAISThorax = 2 injuries increased with age while that of MAISThorax = 3 injuries decreased. A total of 16.2% patients died. Serious (AIS≥3) thoracic injuries (OR = 12.4, 95%CI [8.6;18.0]) were strongly associated with mortality but less than were TBI (OR = 27.9, 95%CI [21.3;36.7]).

Conclusion: Moderate to lethal RTA-related thoracic injuries were rare. Multiple ribs fractures, pulmonary contusions, and sternal fractures were the most frequent anatomical injuries. The incidence, injury pattern and mechanisms greatly vary across age groups.

Fig 1. Road traffic accident among the AIS_Thorax≥2 group per 100,000 inhabitants in the Rhône area population.

Subgroups according to the age. AIS_Thorax≥2 group: trauma patients presenting with at least one thoracic injury AIS≥2.AIS: abbreviated injury scale.

Fig 2. Road user category distribution among the AIS_Thorax≥2 group.

Subgroups according to the age. AIS_Thorax≥2 group: trauma patients presenting with at least one thoracic injury AIS≥2. AIS: abbreviated injury scale. MAIS: maximum abbreviated injury scale.

Fig 3. Thoracic MAIS distribution among the AIS_Thorax≥2 group.

Subgroups according to the age. AIS_Thorax≥2 group: trauma patients presenting with at least one thoracic injury AIS≥2. AIS: abbreviated injury scale. MAIS: maximum abbreviated injury scale.