Objective To investigate the causes of death and evaluation of injury severity in patients with thoracic trauma so as to enhance the diagnosis and treatment of thoracic trauma. Methods A retrospective study was carried out in 687 patients with thoracic trauma, which were divided into different groups according to their condition of injury (chest injury group and multiple injuries group) and outcome (survival group and death group) and penetrating into pleural cavity (penetrating injury group and blunt trauma group), then trauma scores(revised trauma score,abbreviated injury scale,injury severity score,probability of survival)were compared respectively. In addition, the highrisk causes of trauma death were analyzed. Results Among 687 cases, there are 488 cases with blunt trauma and 199 cases with penetrating injury. The causes of trauma death in blunt trauma group were brain injury (10 cases) and acute respiratory failure (6 cases) and multiple organ dysfunction syndrome (4 cases) and hypovolemic shock (1 case). The causes of trauma death in penetrating trauma group were hypovolemic shock (9 cases). There were statistically difference of trauma score in the death group and the survival group（GCS：t=4.648,P=0.000; RTS:t=4.382,P=0.000;thoracic AIS：t=2.296,P=0.027;ISS：t=4.871，P=0.000; Ps：t=4.254,P=0.000）. There was no statistically difference of thoracic AIS in the chest injury group and the multiple injuries group (t=0.723, P=34.567), and there were statistical significances in RTS（t=2.553,P=0.032）, ISS（t=10.776,P=0.000）, Ps（t=3.868,P=0.007）. There were statistically difference of RTS（t=3.161,P=0.007）and ISS （t=4.118,P=0.005） in the blunt trauma survival group and penetrating injury survival group, and there was no statistical significance in Ps（t=0.857,P=97.453）. The blunt trauma death group had statistical difference compared with penetrating injury death group in trauma score（GCS：t=4.016,P=0.001，RTS:t=3.168,P=0.006;thoracic AIS：t=2.303, P=0.043;ISS：t=4.218,P=0.002;Ps：t=4.624,P=0.001）. The mortality of trauma was gradually increased with the trauma scores. The mortality was 10.7% when whole ISS was 20.25. The mortality in penetrating injury group was higher than that in blunt trauma group with the same ISS between two groups. Conclusion Applying trauma score is conducive to the judgement of trauma severity and optimizing clinical treatment. The death causes in blunt trauma group were more complex than in penetrating injury group. Severe trauma and multiple injuries are the main death causes of thoracic trauma.
Objective To summarize the treatment and outcomes of patients with multiple injuries combined with thoracic trauma following the Wenchuan earthquake. Methods The wounded patients admitted from 12th to 31st May with multiple injuries combined with thoracic trauma after the earthquake were retrospectively analyzed. This includes baseline information, treatments, outcomes and deaths. Results Liver repair, spleen abscission, decompression and removed of intracranial hematoma ranked the first three of the main reasons for the emergency surgery death of multiple injuries. Heart-lung machine support, trachea cannula and closed drainage of thoracic cavity ranked the first three of the main reasons for the death of thoracic trauma. Moreover, ARDS, fracture of sternum and flail chest ranked the first three of the main reasons for the death of other multiple injuries. All the casualties had the worst situation with high ISS scores. The main death reasons were cerebral wound, peritoneum viscera injuries and the four limbs and pelvis injuries. Besides, the severe thoracic trauma accelerated their death. Conclusion Main death reasons for the inpatients with multiple injuries combined with thoracic trauma are hemorrhagic shock and severe cerebral wound. The thoracic trauma degree will increase the risk of their death. The more the injury positions, the higher ISS scores, and the more serious thoracic trauma, the higher mortality rate. Rapid examination and diagnosis, rapied triage and distribution of thoracic trauma can help to create more chances for the further treatment and increase the success rate of rescue.