Road traffic accident-related thoracic trauma: Epidemiology, injury pattern, outcome, and impact on mortality—A multicenter observational study

Benhamed, Axel; Ndiaye, Amina; Emond, Marcel; Lieutaud, Thomas; Boucher, Valérie; Gossiome, Amaury; Laumon, Bernard; Gadegbeku, Blandine; Tazarourte, Karim · 2022 · Crossref

DOI: 10.1371/journal.pone.0268202

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Summary

This multicenter observational study investigates the epidemiology, injury patterns, and mortality impact of thoracic trauma resulting from road traffic accidents (RTAs). While thoracic injuries are a leading cause of death in trauma patients, their specific characteristics within the context of RTAs have been poorly described compared to non-RTA traumas. The study aimed to characterize these injuries and determine the influence of serious thoracic trauma on mortality relative to other severe injuries. The researchers utilized prospectively recorded data from the Rhône RTA registry in France, covering the period from 1997 to 2016. The study population included 176,346 RTA victims who required institutional healthcare. The analysis focused on a subgroup of 6,382 patients (3.6% of the total) who sustained at least one moderate to lethal thoracic injury, defined as an Abbreviated Injury Scale (AIS) score of 2 or higher. Data collection included demographic characteristics, road user categories, injury severity scores, and outcomes such as intensive care unit admission and mortality. Statistical analysis involved descriptive statistics and multivariate logistic regression to assess mortality risk factors. The results indicated that moderate to lethal RTA-related thoracic injuries were relatively rare. The affected population was predominantly male (68.9%) with a median age of 41 years. Car occupants constituted the largest group of victims (52.3%), followed by motorcyclists (25.3%). Chest wall injuries were the most frequent anatomical injuries (62.1%), with multiple rib fractures accounting for over half of these cases. Lung injuries, primarily pulmonary contusions, were the second most common (24.7%). Traumatic brain injuries were the most frequent concomitant extra-thoracic injuries (29.1%). The overall mortality rate for patients with thoracic injuries was 16.2%, with 61.5% of deaths occurring on the scene. Pedestrians exhibited the highest mortality proportion (30.6%). Multivariate analysis revealed that serious thoracic injuries (AIS ≥ 3) were strongly associated with mortality (Odds Ratio [OR] = 12.4), though this risk was lower than that associated with serious traumatic brain injuries (OR = 27.9). Other significant predictors of mortality included older age, male sex, and accidents occurring on highways or rural roads. The study concludes that while significant thoracic trauma is less common in RTAs than previously reported, it remains a critical factor in traumatic mortality. The injury patterns vary significantly by age, with children more likely to suffer severe internal injuries due to skeletal compressibility, while older adults are more prone to rib fractures. The findings highlight that serious thoracic injuries are a major independent predictor of death, particularly in the immediate aftermath of an accident. This data provides essential epidemiological context for trauma care strategies and underscores the need for targeted interventions for high-risk groups, such as elderly pedestrians and motorcyclists.

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• incidence prevalence