Epidemiology and Impact of Thoracic Trauma on the Mortality of Multi-trauma Patients: Results From a French Road Trauma Registry 1997-2016

Benhamed, Axel; Ndiaye, Amina; Emond, Marcel; Lieutaud, Thomas; Douplat, Marion; Gossiome, Amaury; Laumon, Bernard; Gadegbeku, Blandine; Tazarourte, Karim · 2021 · Crossref

DOI: 10.21203/rs.3.rs-855268/v1

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Summary

This study investigates the epidemiology and impact of thoracic trauma on the mortality of multi-trauma patients resulting from road traffic accidents (RTAs). Motivated by the fact that thoracic trauma is the third leading cause of death in multi-trauma cases and contributes significantly to trauma-related mortality, the research aimed to determine the influence of severe injuries (Abbreviated Injury Scale, AIS ≥ 3) in various body regions on patient survival, with a specific focus on the thorax. Additionally, the study sought to describe the injury patterns and demographics of patients presenting with at least one thoracic injury of AIS ≥ 2. The researchers conducted a retrospective analysis using prospectively recorded data from the Rhône RTA registry in France, covering the period from 1997 to 2016. The study included 46,526 patients who sustained at least one injury with an AIS score of 2 or higher. Participants were divided into two subgroups: those with at least one thoracic injury of AIS ≥ 2 (n=6,382) and those without. Injury severity was coded using the AIS system, and mortality was the primary outcome. Multivariate logistic regression analysis was performed to identify risk factors for death, adjusting for variables such as age, sex, road user category, and injury severity in other body regions. The results indicated that 13.7% of the multi-trauma patients had significant thoracic injuries. Severe thoracic injuries (AIS ≥ 3) were strongly associated with mortality, with an odds ratio (OR) of 12.2 (95% CI [8.4; 17.7]), ranking second only to severe head injuries (OR=26.8). Among patients with thoracic trauma, chest wall injuries were the most frequent (62.1%), primarily consisting of multiple rib fractures, followed by lung injuries (24.7%), predominantly pulmonary contusions. Mortality rates varied by injury severity, with 47.3% of patients having a maximum thoracic AIS score of 4 or higher succumbing to their injuries. Pedestrians exhibited the highest mortality rate among road user categories (30.6%). Furthermore, the study found that the incidence of AIS 3 thoracic injuries was highest in children and decreased with age, whereas AIS 2 injuries increased with age, likely due to osteoporosis in older adults. The study concludes that the severity of thoracic trauma is an independent and significant risk factor for death in multi-trauma patients. The findings underscore the critical importance of early detection and management of thoracic injuries, particularly given that a majority of deaths occurred within the first 24 hours. The inclusion of on-scene deceased patients, verified by autopsy, provided a comprehensive assessment of mortality, distinguishing this study from those excluding pre-hospital deaths. These results highlight thoracic trauma as a priority in the care of multi-trauma victims, influencing both clinical management strategies and public health understanding of RTA outcomes.

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• fatality injury trends