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. 2023 Apr;49(2):1131-1143.
doi: 10.1007/s00068-022-02177-6. Epub 2022 Dec 17.

Comorbidities, injury severity and complications predict mortality in thoracic trauma

Anne T Fokkema  1 , Bergros K Johannesdottir  2   3 , Klaus Wendt  4 , Rune Haaverstad  2   5   6 , Inge H F Reininga  4 , Thomas Geisner  7
Affiliations

Comorbidities, injury severity and complications predict mortality in thoracic trauma

Anne T Fokkema et al. Eur J Trauma Emerg Surg. 2023 Apr.

Abstract

Purpose: Thoracic trauma accounts for 25-50% of posttraumatic mortality. Data on epidemiology of thoracic trauma in Scandinavia and risk factors for mortality are scarce. This study aims to provide an overview of epidemiology, clinical events and risk factors for mortality of patients with severe thoracic injuries.

Methods: A retrospective study including adult thoracic trauma patients with abbreviated injury scale ≥ 3, between 2009 and 2018 at Haukeland University Hospital was performed. Subgroup analyses were performed for specific patient groups: (1) isolated thoracic trauma, (2) polytrauma without Traumatic Brain Injury (TBI) and (3) polytrauma with TBI. Logistic regression analyses were applied to find risk factors for 30-days mortality. Age, sex, comorbidity polypharmacy score (CPS), trauma and injury severity score (TRISS) and comprehensive complication index (CI) were included in the final model.

Results: Data of 514 patients were analyzed, of which 60 (12%) patients died. Median (IQR) injury severity score (ISS) was 17 (13-27). Data of 463 patients, of which 39 patients died (8%), were included in multivariate analyses. Female sex odds ratio (OR) (2.7, p = 0.04), CPS > 9 (OR 4.8; p = 0.01), TRISS ≤ 50% (OR 44; p < 0.001) and CI ≥ 30 (OR 12.5, p < 0.001) were significant risk factors for mortality. Subgroup analyses did not demonstrate other risk factors.

Conclusion: Comorbidities and associated pharmacotherapies, TRISS, female sex, and complications during admission predict in-hospital mortality after thoracic trauma. Current findings might help to recognize patients at risk of an adverse outcome, and thereby prevent complications.

Trial registration: RETROSPECTIVELY REGISTERED: The regional committees for medical and health research ethics file number is 2017/293.

Keywords: Comorbidity; Mortality; Polypharmacy; Thoracic injuries; Trauma; Triage.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of included and excluded patients for descriptive and regression analyses
Fig. 2
Fig. 2
Annual incidence of thoracic trauma per 100,000 inhabitants in Haukeland University Hospital catchment area per year and sex
Fig. 3
Fig. 3
Frequencies and nature of severe complications. CDS grade 1 requires no treatment, CDS grade 2 requires pharmalogical treatment, CDS grade 3 requires surgical treatment, CDS grade 4 requires intensive care, CDS grade 5 death ()
Fig. 4
Fig. 4
Temporal distribution of mortality. Abbreviations: TBI traumatic brain injury
See this image and copyright information in PMC

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