Prognostic evaluation of cases with thoracic trauma admitted to the intensive care unit: 10-year clinical outcomes

Abstract

BACKGROUND: Multiple traumas are a leading cause of mortality among young adults worldwide. Thoracic trauma causes approximately 25% of all trauma-associated deaths. This study aims to determine the independent prognostic factors of mortality in cases with thoracic trauma (isolated or with accompanying organ injuries) who were admitted to the intensive care unit (ICU). METHODS: We retrospectively reviewed data from patients with thoracic trauma who were admitted to our ICU between 2007 and 2016. After excluding pediatric patients (aged < 18 years), the study sample included 564 cases. From the records, we collected the patients' demographical data, comorbid diseases, primary trauma as an indication for ICU admission, other traumas accompanying thoracic trauma, type of thoracic injury, and therapeutic interventions. The study sample was divided into two subsets: survival and non-survival groups. These two groups were compared with regards to first ICU day laboratory results and intensive care scores, mechanical ventilation times, and ICU stay lengths. RESULTS: Of the 8063 patients admitted to the ICU between 2007 and 2016, 616 (7.6%) had thoracic trauma. The median age (min-max) of the 564 patients eligible for this study was 43 (18-87) years. Mortality occurred in 159 (28.1%) cases, while 405 (71.8%) were discharged from the ICU. Multivariate regression analyses were also performed, in which every increment in age was associated with a 1.025-fold increase in the odds of mortality due to thoracic trauma. Additionally, the presence of central nervous system (CNS) trauma was associated with a 2.147-fold increase, and the presence of pulmonary contusion was associated with a 1.752-fold increase. CONCLUSION: Results of this study indicate that advanced age, the presence of pulmonary contusion, and accompanying CNS trauma are independent predictors of mortality in patients with thoracic trauma in the ICU. Our non-invasive approach is further supported by the trauma and injury severity score (TRISS) scoring system, which is one of the latest scoring systems used in trauma cases.