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

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

DOI: 10.21203/rs.3.rs-682244/v1

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Summary

This study investigates the 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 accounts for up to 25% of trauma-related deaths, the research aimed to determine the influence of severe injuries in specific body regions on mortality, with a particular focus on the thorax. Secondary objectives included identifying risk factors for mortality and describing the epidemiology and injury patterns of patients with at least one thoracic injury scored as AIS ≥ 2. The researchers conducted a retrospective analysis using data from the Rhône RTA registry in France, covering the period from January 1997 to December 2016. The study included 46,526 patients of all ages who sustained at least one injury with an Abbreviated Injury Scale (AIS) score of ≥ 2. Participants were divided into two subgroups: those with at least one thoracic injury of AIS ≥ 2 (n = 6,382) and those without. Multivariate logistic regression was performed to assess mortality as the primary outcome, controlling for variables such as age, sex, road user category, and road network type. Patients with severe burn injuries were excluded from the regression analysis due to distinct mortality mechanisms. The results indicated that 13.7% of the cohort had thoracic injuries of AIS ≥ 2, with a mortality rate of 16.2% in this subgroup. Severe head injuries (AIS ≥ 3) were the strongest predictor of death (OR = 26.8), followed by severe thoracic injuries (OR = 12.2). Other significant independent risk factors for mortality included advanced age (OR = 5.5 for patients ≥ 80 years), male sex (OR = 1.5), and accidents occurring on highways (OR = 1.9) or rural roads (OR = 1.8) compared to city streets. The most common thoracic injury was chest wall trauma (62.1%), primarily multiple rib fractures, followed by lung injuries (24.7%), predominantly pulmonary contusions. Mortality was highest among pedestrians (30.6%) and lowest among bicyclists (10.5%). Notably, 75.8% of deaths in the thoracic trauma group occurred within the first 24 hours. The study concludes that the severity of thoracic trauma is an independent and significant risk factor for death in multi-trauma patients, second only to severe head trauma. The findings highlight that older age, male sex, and crash location (highway or rural road) further exacerbate mortality risk. These results underscore the critical nature of thoracic injuries in RTA outcomes, suggesting that specific attention to chest trauma management and prevention strategies for high-risk demographics and road types is essential for improving survival rates in multi-trauma care.

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• fatality injury trends