Document Detail

Unilateral flail chest is seldom a lethal injury.
MedLine Citation:
PMID:  17130594     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The chest cage is a common target for traumatic damage. Although relatively rare, it is considered to be a serious condition with significant reported mortalities. As most flail injuries are accompanied by severe extrathoracic injuries, it is often difficult to pinpoint a single injury responsible for the patient's death.
AIM: To investigate the factors related to mortality when flail injury is diagnosed.
METHODS: Data from the Israel National Trauma Registry between 1998 and 2003 included 11,966 chest injuries (262 flail chest injuries) out of a total of 118,211 trauma hospitalisations. Mortality figures were analysed to determine which factors, singly or in combination, influenced flail chest mortality.
RESULTS: Road crashes accounted for most flail injuries (76%). The total mortality was 54 (20.6%) of 262 patients with flail chest injuries. 13 (20.4%) of the deaths occurred soon after admission to the emergency room and 37 (68.5%) within the first 24 h. Mortality in moderate to severe injuries (injury severity score (ISS) 9-24) was 3.6% and that in critical injuries 28.5% (ISS >24). Mortality increased with age: 17% in those aged <45 years, 22.1% in those between 45 and 64 years and 28.8% in those >65 years. Age remained a risk for inpatient death when adjusted for severity. Mortality in isolated unilateral flail injury was not more than 6%. Total mortality for traumatic brain injury (TBI) and flail was 34%. Flail, TBI and other major injuries increased the mortality to 61.1%.
CONCLUSIONS: Advanced age is associated with higher mortality. Isolated unilateral bony cage instability infrequently leads to death in patients who make it to the emergency department but rather its combination with additional extrathoracic trauma.
J B Borman; L Aharonson-Daniel; B Savitsky; K Peleg;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  23     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-11-28     Completed Date:  2006-12-26     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  903-5     Citation Subset:  IM    
Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
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MeSH Terms
Accidents, Traffic
Age Factors
Child, Preschool
Flail Chest / etiology,  mortality*
Hospital Mortality
Hospitalization / statistics & numerical data
Infant, Newborn
Injury Severity Score
Israel / epidemiology
Middle Aged
Multiple Trauma / mortality
Retrospective Studies
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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