Objective To investigate the causes of death and evaluation of injury severity in patients with thoracic trauma so as to enhance the diagnosis and treatment of thoracic trauma. Methods A retrospective study was carried out in 687 patients with thoracic trauma, which were divided into different groups according to their condition of injury (chest injury group and multiple injuries group) and outcome (survival group and death group) and penetrating into pleural cavity (penetrating injury group and blunt trauma group), then trauma scores(revised trauma score,abbreviated injury scale,injury severity score,probability of survival)were compared respectively. In addition, the highrisk causes of trauma death were analyzed. Results Among 687 cases, there are 488 cases with blunt trauma and 199 cases with penetrating injury. The causes of trauma death in blunt trauma group were brain injury (10 cases) and acute respiratory failure (6 cases) and multiple organ dysfunction syndrome (4 cases) and hypovolemic shock (1 case). The causes of trauma death in penetrating trauma group were hypovolemic shock (9 cases). There were statistically difference of trauma score in the death group and the survival group（GCS：t=4.648,P=0.000; RTS:t=4.382,P=0.000;thoracic AIS：t=2.296,P=0.027;ISS：t=4.871，P=0.000; Ps：t=4.254,P=0.000）. There was no statistically difference of thoracic AIS in the chest injury group and the multiple injuries group (t=0.723, P=34.567), and there were statistical significances in RTS（t=2.553,P=0.032）, ISS（t=10.776,P=0.000）, Ps（t=3.868,P=0.007）. There were statistically difference of RTS（t=3.161,P=0.007）and ISS （t=4.118,P=0.005） in the blunt trauma survival group and penetrating injury survival group, and there was no statistical significance in Ps（t=0.857,P=97.453）. The blunt trauma death group had statistical difference compared with penetrating injury death group in trauma score（GCS：t=4.016,P=0.001，RTS:t=3.168,P=0.006;thoracic AIS：t=2.303, P=0.043;ISS：t=4.218,P=0.002;Ps：t=4.624,P=0.001）. The mortality of trauma was gradually increased with the trauma scores. The mortality was 10.7% when whole ISS was 20.25. The mortality in penetrating injury group was higher than that in blunt trauma group with the same ISS between two groups. Conclusion Applying trauma score is conducive to the judgement of trauma severity and optimizing clinical treatment. The death causes in blunt trauma group were more complex than in penetrating injury group. Severe trauma and multiple injuries are the main death causes of thoracic trauma.
ObjectiveTo evaluate prehospital treatment strategies of rescuers and first-line hospitals for thoracic trauma victims after Lushan earthquake, and provide reference for making emergency response plans, staff training, and preparedness of material and human resources for future disasters. MethodsClinical data of 365 victims in Lushan '4.20' earthquake who received treatment in West China Hospital were retrospectively analyzed. Among them, 63 victims had thoracic trauma, including 40 males (63.5%)and 23 females (36.5%)with their age of 49.08±19.10 years. There were 244 victims with orthopedic trauma, including 133 males (54.5%)and 111 females (45.4%)with their age of 41.59±22.74 years. Prehospital treatment methods (including specific treatment and general treatment)were compared between thoracic trauma victims and orthopedic trauma victims. ResultsAmong all the thoracic trauma victims, 51 victims required specific pre-hospital treatment, but only 10 (19.6%)victims actually received it. Among all the orthopedic trauma victims, 220 victims required specific prehospital treatment, but actually 162 (73.6%)victims received it. The percentages of thoracic and orthopedic victims who received specific prehospital treatment were statistically different (P < 0.01). There was no statistical difference in the percentage of victims who received general treatment between thoracic and orthopedic trauma victims (P > 0.05). ConclusionsThoracic trauma victims receive less specific prehospital treatment than orthopedic trauma victims from rescuers and first-line hospitals after Lushan earthquake. More specific prehospital treatment is needed for thoracic trauma victims in disaster rescue in the future.
Thoracic trauma has the characteristics of complexity, specificity, urgency and severity. Therefore, the treatment is particularly important. Thoracic Traumatology Group, Trauma Medicine Branch of Zhejiang Medical Association organized the writing of the thoracic trauma and further optimization consensus of Zhejiang thoracic surgery industry Treatment and diagnosis of rib and sternum trauma: A consensus statement by Zhejiang Association for Thoracic Surgery (version 2021), compiled the popular science book Emergency Treatment and Risk Avoidance Strategy of Thoracic Trauma and Illustration of Real Scene Treatment of Trauma, actively prepared to build the trauma database of Zhejiang Province, and participated in the construction of trauma group in the Yangtze River Delta. Although Zhejiang Province has carried out many related works in the diagnosis and treatment of chest trauma, it is still inconsistent with the development requirements of the times. Standardization of chest trauma treatment, popularization of relevant knowledge, management of trauma big data, grass-roots radiation promotion tour and further optimization of industry consensus are the requirements and objectives of this era.