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Unilateral flail chest is seldom a lethal injury
J B Borman1, L Aharonson-Daniel, B Savitsky
1Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
Emergency Medicine Journal : EMJ
|November 30, 2006
Summary
Flail chest injuries are serious, with mortality increasing with age and severity. Combination with traumatic brain injury and other major trauma significantly elevates death risk.
Area of Science:
- Trauma surgery
- Emergency medicine
- Critical care
Background:
- Flail chest injuries, though rare, are severe thoracic trauma with high mortality.
- Extrathoracic injuries often complicate the assessment of flail chest mortality.
Purpose of the Study:
- To identify factors influencing mortality in patients diagnosed with flail chest injury.
- To analyze the impact of age, injury severity, and associated injuries on flail chest outcomes.
Main Methods:
- Retrospective analysis of 262 flail chest cases from the Israel National Trauma Registry (1998-2003).
- Inclusion of 11,966 chest injuries within 118,211 total trauma hospitalizations.
- Statistical analysis of mortality factors, including age, Injury Severity Score (ISS), and co-existing injuries like Traumatic Brain Injury (TBI).
Main Results:
- Road crashes were the primary cause (76%) of flail chest injuries.
- Overall mortality was 20.6% (54/262), with most deaths occurring within 24 hours.
- Mortality significantly increased with higher ISS (3.6% for ISS 9-24 vs. 28.5% for ISS >24) and advanced age (17% <45 yrs to 28.8% >65 yrs).
- Isolated unilateral flail chest had low mortality (<6%), but combined with TBI and other major injuries, mortality reached 61.1%.
Conclusions:
- Advanced age is an independent risk factor for increased mortality in flail chest patients.
- Isolated bony cage instability is rarely fatal; mortality is driven by associated extrathoracic trauma, particularly TBI.
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Assessment:
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