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Cohort Study on the Prevalence and Risk Factors for Delayed Pulmonary Complications in Adults Following Minor Blunt Thoracic Trauma

Published online by Cambridge University Press:  04 March 2015

Miville Plourde ,
Marcel Émond ,
André Lavoie ,
Chantal Guimont ,
Natalie Le Sage ,
Jean-Marc Chauny ,
Éric Bergeron ,
Laurent Vanier ,
Lynne Moore  and
Nadine Allain-Boulé
...Show all authors
Miville Plourde*
Affiliation:
Centre hospitalier universitaire de Québec, Hôpital Saint-François d’Assise, Québec, QC
Marcel Émond
Affiliation:
Trauma-emergency-intensive care department, Centre de recherché FRSQ du CHA, Québec, QC
André Lavoie
Affiliation:
Trauma-emergency-intensive care department, Centre de recherché FRSQ du CHA, Québec, QC
Chantal Guimont
Affiliation:
Reproduction, perinatal health and children’s health department, Québec, QC
Natalie Le Sage
Affiliation:
Trauma-emergency-intensive care department, Centre de recherché FRSQ du CHA, Québec, QC
Jean-Marc Chauny
Affiliation:
Centre de recherché de l’hôpital du Sacré-Coeur de Montréal, Montréal, QC
Éric Bergeron
Affiliation:
Trauma-emergency-intensive care department, Centre de recherché FRSQ du CHA, Québec, QC
Laurent Vanier
Affiliation:
Hôpital Charles Lemoyne, Greenfield Park, QC
Lynne Moore
Affiliation:
Trauma-emergency-intensive care department, Centre de recherché FRSQ du CHA, Québec, QC
Nadine Allain-Boulé
Affiliation:
Trauma-emergency-intensive care department, Centre de recherché FRSQ du CHA, Québec, QC
Ramona-Florina Fratu
Affiliation:
Trauma-emergency-intensive care department, Centre de recherché FRSQ du CHA, Québec, QC
Maryline Dufresne
Affiliation:
Trauma-emergency-intensive care department, Centre de recherché FRSQ du CHA, Québec, QC
*
Université Laval, Québec, CHUQ – Hôpital Saint-François d’Assise, 10 de l’Espinay Street, QC GIL 3L5; [email protected].

Abstract

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Objectives:

The objectives of this study are to determine the prevalence, risk factors, and time to onset of delayed hemothorax and pneumothorax in adults who experienced a minor blunt thoracic trauma.

Method:

A prospective cohort of 450 consecutive patients was recruited. Eligible patients had to be over 16 years of age, consulted within 72 hours for a trauma, and available for outpatient follow-up at 2, 7, and 14 days posttrauma. The clinical outcome investigated was the presence of delayed pneumothorax or hemothorax on the follow-up chest x-ray.

Outcomes:

Delayed hemothorax occurred in 11.8% (95% CI 8.8–14.8), and delayed pneumothorax occurred in 0.9% (95% CI 0.2–2.3) of participants. During the 14-day follow-up period, 87.0% of these delayed complications developed in the first week. In the multivariate analysis, the only statistically significant risk factor for delayed complications was the location of fractures on the x-ray of the hemithorax. The adjusted odds ratio was 1.52 (95% CI 0.62–3.73) for the lower ribs (tenth to twelfth rib), 3.11 (95% CI 1.60–6.08) for the midline ribs (sixth to ninth rib), and 5.05 (95% CI 1.80–14.19) for the upper ribs (third to fifth rib) versus patients with no fractures.

Conclusion:

The presence of at least one rib fracture between the third and ninth rib on the x-ray of the hemithorax is a significant risk factor for delayed hemothorax and pneumothorax.

Keywords

delayed hemothoraxdelayed pneumothoraxlate hemothoraxlate pneumothoraxthoracic trauma
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 2 , March 2014 , pp. 136 - 143
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

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