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[Prognostic pulmonary and thoracic findings in patients with unstable injuries of the thoracic spine]

BACKGROUND: Instable fractures of the thoracic spine imply a substantial trauma to the chest. The aim of this study was to undertake a systematic analysis of the prognostic impact of CT findings of the chest wall, mediastinum, lungs, and pleural space on the mortality rate. METHOD: All multiple injury patients with instable fractures of the thoracic spine and initial CT scans treated in our clinic from April 2004 to May 2007 were eligible. The following variables were evaluated for their prognostic power: injury to the lungs (pneumothorax, effusion, lung contusions/lacerations, atelectasis), mediastinum (vessel dissection/rupture, bleeding, diaphragmatic rupture), chest wall (bruises, soft tissue emphysema, rib fractures), and need for pre-diagnostic tube thoracostomy. The significance level was set to P = 0.05. PATIENTS: Of a total of 33 patients (mean age: 43.5 +/- 20.1 years [range 14 – 83 years]; 25-male [76 %]), seven patients (21 %) died with women being significantly more affected (P < 0.001). Mortality rate was not influenced by patient age. RESULTS: Non-survivors displayed significantly higher median lung contusion score values compared to survivors (4.0 [0 - 12] versus 1.0 [0 - 10]; P = 0.016). The following variables revealed a significant association with the mortality rate: chest wall bruises with soft tissue emphysema > 90 degrees of the thoracic circumference (sensitivity [SE]: 43 %, specificity [SP]: 100 %, positive predictive value [PPV]: 100 %, negative predictive value [NPV]: 87 %, overall accuracy [OA]: 88 %; P = 0.006), rib fractures (SE: 71 %, SP: 81 %, PPW: 50 %, NPW: 91 %, OA: 79 %; P = 0.016), mediastinal haematoma (SE: 71 %, SP: 77 %, PPW: 45 %, NPW: 91 %, OA: 76 %; P = 0.027), and bilateral pneumothoraces (SE: 29 %, SP: 100 %, PPW: 100 %, NPW: 84 %, OA: 85 %; P = 0.040). CONCLUSION: Multiply injured patients with instable fractures of the thoracic spine display CT findings indicative of non-survival. Image acquisition and interpretation focusing solely on the spine should be avoided to ensure the detection of prognostic injury patterns to the lungs

Keywords : Adolescent,Adult,Aged,Aged,80 and over,Comorbidity,diagnostic imaging,epidemiology,Female,Germany,Humans,injuries,Lung,Lung Injury,Male,Middle Aged,mortality,Multiple Trauma,Pneumothorax,Prevalence,Prognosis,Radiography,Risk Assessment,Risk Factors,Spinal Fractures,Spine,Survival Analysis,Survival Rate,Thoracic Injuries,Thoracic Vertebrae,Young Adult,, Pulmonary,Thoracic,Findings, chronic myofascial pain

Date of Publication : 2011 Jul

Authors : Lemburg SP;Frangen TM;Knoop H;Nicolas V;Heyer CM;

Organisation : Institut fur Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin, Berufgenossenschaftliches Universitatsklinikum Bergmannsheil GmbH, Ruhr-Universitat Bochum

Journal of Publication : Pneumologie

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21370221

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