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PubMed2006

Does the frontal airbag avoid thoracic injury?

INTRODUCTION: The airbag is an established car safety device. However, recent studies pointed out that even the airbag might cause injuries. Nevertheless, most physicians do consider a lower risk in accident victims sustaining severe injury of the chest, when a deployed frontal airbag has been reported. We set out to verify the frequency and pattern of thoracic injury in car drivers protected by a frontal airbag during traffic accidents. METHODS: This investigation was conducted as part of a prospective surveillance analyzing traffic accidents. Enrolled were car drivers included in a databank between January 2001 and December 2004 consecutively. The chance for sustaining chest injury with or without a frontal airbag was described using the relative risk. RESULTS: A total of 188 car drivers were included in the analysis. In 54 (28.7%) cases a deployed airbag and in 134 (71.3%) the absence of an airbag has been documented. Out of those cases 16 (29.6%) drivers with airbag and 30 (22.4%) without airbag sustained a chest injury. The mean abbreviated injury scale (AIS) of chest injuries in drivers with deployed airbag was 2.3 (1-5; SD +/- 1.45; mean injury severity scale [ISS] 21.1 [SD +/- 17.18]), in drivers without airbag 1.6 (1-4; SD +/- 1.12; mean ISS 15.8 [SD +/- 20.6]). For belted drivers with an airbag the relative risk to sustain chest injury was 1.96 compared to those without an airbag. CONCLUSIONS: The airbag does not avoid chest injury definitively. Much more, it has been demonstrated that the relative risk to sustain relevant thoracic injury seems to be almost higher in restrained drivers with a frontal airbag.

Accidents, Traffic↗
PubMed1992

[Practical aspects of thoracic injuries].

While mortality is about one per hundred in patients with injuries to the chest wall it is one in five in patients with internal thoracic injuries. The mortality is dependent on the total severity of injuries, and upon age. Closed, blunt thoracic trauma may initially present few signs and symptoms. Internal injuries, such as pneumothorax and haemothorax may be present. Decompression by thoracic drainage improves oxygenation. This may be crucial for the prognosis in multitrauma, particularly in cases of concomitant head injury. Treatment and diagnosis of thoracic injuries have first priority in the multitraumatized patient. A chest X-ray should be obtained early, and should be repeated, possibly supplemented by a CT-scan. When pneumothorax or haemothorax is suspected, and in cases of penetrating injury, chest drainage is widely used. In cases of chest injury and unexplained shock, cardiac tamponade must be excluded by subxiphoidal incision.

Drainage↗
PubMed1990

[Clinical aspects, diagnosis and treatment of cranio-thoracic injuries in patients of different age].

The comparative analysis of the clinical manifestations and informative value of the adjuvant methods of investigation in 125 patients with ++cranio-thoracic injuries and 53 patients with isolated craniocerebral trauma was carried out. This permitted to define more precisely the possibilities of the methods of neurosurgical diagnosis and find the optimal methods for the treatment of patients of different age with ++cranio-thoracic injuries.

Adult↗
PubMed2005

Thoracic Injury Investigation using PMHS in Frontal Airbag Out-of-Position Situations.

Many studies have reported multiple rib fractures sustained by an Out-of-Position (OOP) driver subjected to a frontal airbag deployment, but the injury mechanisms and thresholds remain unclear. Two successive phases occur during the bag deployment: punch-out loading of the thorax, followed by a membrane effect (Horsch et al. 1990). The aim of this study was to investigate the thoracic injuries generated by each phase separately. Tests of nine post-mortem human surrogates (PMHS) were carried out on a static test bench using a driver side airbag module described by Petit et al. (2003). The steering wheel was replaced by a plate in order to increase the loading generated by the airbag. Three loading configurations were performed: membrane only, punch-out only, and both types combined. The membrane-only tests were performed with the thorax initially positioned at 13, 78 and 128 mm from the plate in order to vary the load magnitude. The punch-out and the combined tests were performed with the thorax initially 8 mm from the module. Accelerometers and angular rate sensors were fixed on the sternum and on the first, fourth, and eighth thoracic vertebrae of the PMHS. Ribs 2 to 6 were instrumented with strain gauges. The reaction force of the bag on the plate was measured using four 2-axis load cells. Results show that both pure punch-out and pure membrane loading can result in thoracic injuries. However, the rib fracture locations seemed to differ from one type of loading to the other. Moreover, for the same initial distance between the airbag module and the thorax, the injuries were more severe in the combined effect tests than in the pure punch-out or pure membrane. The nine PMHS tests formed a matrix allowing validation of a finite element model and further analysis of thoracic injury mechanisms and thresholds.

Journal Article↗
PubMed1991

[Blunt thoracic injuries in Oslo].

All 327 patients treated in Oslo City Hospital for blunt chest injuries during a period of three months were registered prospectively. 274 were treated outside hospital. Traffic accidents accounted for 10% of the total number of patients, but 40% of the hospitalized patients. Accidents in the home were most numerous, with many complications and admissions to hospital. 20% of the hospitalizations, were for injuries due to violence. The registration indicates more than 1,300 patients with chest injuries per year, of whom more than 40 are severely multitraumatized. The chest injury was serious in 21 patients, moderate in 306. 13.5% of the cases were complicated by pneumo-hemothorax and lung contusion, or by late complications such as pneumonia and atelectases. Seven patients (2.1%) died. These were old, physically disabled or multitraumatized. 100 patients had extrathoracic injuries, of whom 15 had intrathoracic injuries as well. In 227 patients with thoracic injuries only, the injuries were intrathoracic in six of them. The mortality in patients with chest wall injuries only was 0.7%, as compared with 20% in patients with intrathoracic injuries.

Accidents↗
PubMed1985

Penetrating chest wall and thoracic injuries.

Two hundred seventy patients with penetrating chest wall and thoracic injuries were treated at the Metropolitan Nashville General Hospital in a 5.5-year period ending July 1982. Most (250) were males, and the average age was 29.3 years. One hundred thirty-four injuries were the result of gunshot wounds and 18 patients had sustained shotgun wounds. Stab wounds were the cause of injury in 117 patients. Most patients were successfully treated with closed tube thoracostomy. Twenty-five patients required emergency room thoracotomy, and 27 patients were stable enough to be transported to the operating room for thoracotomy and repair of injuries. Survival in the patients who had emergency room thoracotomy was 12 per cent and 78 percent in patients who had operating room thoracotomy. All but one of the patients who died following operating room thoracotomy died within 1 hour of admission. When thoracotomy is indicated, it frequently must be performed very soon after admission. The indications for emergency thoracotomy must be known and recognized early if it is to be an effective procedure.

Adult↗
PubMed2004

Diagnostic imaging of acute thoracic injury.

In recent years, the advent of multidetector CT (MDCT) has begun to change the imaging approach to patients sustaining blunt or penetrating thoracic injury. The ability to directly detect some injuries that are often occult on chest radiography, such as pericardial hemorrhage, major thoracic vascular injury, small pneumothorax, and diaphragm tears, as well as the ability to better define the extent of other injuries, such as lung contusion and laceration, account for this transition. This article reviews current concepts of diagnostic imaging in acute chest trauma from both blunt force and penetrating mechanisms, emphasizing the spectrum of diagnostic imaging findings for various injuries, primarily based on multidetector MDCT.

Acute Disease↗
PubMed1992

[X-ray computed tomography of thoracic injuries. Apropos of 40 cases].

On chest radiographs, the precise assessment of thoracic injuries consecutive to blunt trauma is often compromised by the nonspecific appearance of many lesions. Furthermore, significant injuries are frequently overlooked. However, the management of the patients with chest trauma is still often based primarily upon clinical and radiographic findings and Computed Tomography (CT) is often performed secondarily on the basis of unexplained clinical signs or suspected radiographic abnormality. Some authors have reported that CT was a highly sensitive method for detecting thoracic lesions frequently not seen or underestimated on conventional supine chest radiographs. However, the value that these new CT findings could have in the therapeutic management of these patients, have not been systematically investigated to our knowledge, except in a limited series suggesting that the course of critically ill patients could be substantially altered after thoracic CT. In order to estimate the role of early CT in the management of patient care, we report the therapeutic consequences of CT findings in forty patients who we report the therapeutic consequences of CT findings in forty patients who had a thoracic CT within few hours following a chest injury. We showed that early thoracic CT scan in patients with blunt trauma detected significantly more lesions than did chest X-Ray and appreciably modified the treatment modalities in 70% of our patients. We then recommend that all the patients admitted in ICU after chest trauma undergo a thoracic CT scan as soon as possible in order to optimize their treatment modalities.

Adolescent↗
PubMed1992

A parametric study of the thoracic injury potential of basic taekwondo kicks.

A parametric investigation of the thoracic injury potential of basic taekwondo kicks was conducted through the use of computer simulations. Linkage-based models were employed to simulate the kinetics of the kicking leg and were used to drive a human thorax model. The results of the analysis according to the thoracic compression criterion indicated a minimal probability of severe injury (AIS4+) for swing kicks, nearly 0 percent and thrust kicks, less than three percent. The thoracic viscous criteria, on the other hand, predicted a severe injury probability of up to 100 percent for swing kicks and up to 80 percent for thrust kicks. Additional analysis showed that the injury potential was a strong function of the kick velocity and a weak function of the applied constant force. The injury potential was also found to be a weak function of the size and weight of the kicking leg, with variations in the peak compression and viscous response being typically below 5 percent for a 20 percent change in either the mass or the length.

Biomechanical Phenomena↗
PubMed1997

Management of 240 cases of penetrating thoracic injuries.

We present a review of 240 patients with penetrating thoracic injuries seen in a period of 10 years at a general university hospital in Lima, Peru. The majority of the patients were young males who suffered stab wounds (76.2 per cent). The most frequent symptoms were thoracic pain (N = 202) and dyspnoea (N = 138); and the commonest physical findings were diminished respiratory sounds (N = 192) and tachypnoea (N = 167). Haemopneumothorax (N = 92), haemothorax (N = 81) and pneumothorax (N = 59) were the most frequent lesions. Cardiac lesions were present in 11 patients. The commonest extrathoracic associated lesions was penetrating abdominal injury (N = 43). The majority of the patients only required tube thoracostomy as definitive therapy (N = 143). There were 31 thoracotomies and 54 laparotomies. The most frequent complications were respiratory (N = 34) and neurological (N = 8). Gunshot wounds were more destructive than stab wounds. The first group of patients had a longer hospital stay (11.7 and 7.25 days), longer time with tube thoracostomy (5.98 and 4.18 days), more injured abdominal organs (3.8 and 2.38 organs) and higher mortality (7.01 per cent and 3.82 per cent) than the second group. The overall mortality was 4.58 per cent. The patients with a cardiac lesion had a higher mortality (27.27 per cent) than those who did not (3.49 per cent).

Adolescent↗
PubMed1989

[Clinical study of penetrating thoracic injuries].

During the 13-year period ending in December 1987, 39 patients (pts) of penetrating thoracic injuries were treated. Thirty-five pts (89.7%) were male, and the age range was 21 to 56 years with average of 38.7 years. Thirty-one pts (79.5%) sustained stab wounds and eight (20.5%) had gun-shot wounds. 5 pts died in all (2 pts with stab wounds, 3 with gun-shot wounds). The wounds were limited on chest wall in 14 pts, and penetrated to thorax in 25. In these pts with penetrating wounds, lung injuries were found in 18, heart in 7 and esophagus in 1, respectively. Twenty-one pts had multiple injuries, and abdominal injuries were found in 20 pts (95.2%), limbs in 7 (33.3%), and neck in 2 (9.5%). All 5 dead pts had multiple injuries. Prognoses were fair in cases of simple chest wall injuries or lung injuries. In the cases of lung injuries, thoracotomy was performed in 8 pts (44.4%) and tube thoracostomy in 10 (55.6%). Thoracotomy was performed for massive bleeding (over 600 ml/1-2 hours) (6 cases) and the sites of the injuries suspecting of heart injuries (2 cases). Two pts undergoing tube thoracostomy and one pt done thoracotomy died, but the causes of the death were not related to lung injuries. Regarding the heart injuries, the injured sites were left ventricle in 1, right ventricle in 1, right atrium in 2, and pericardium in 3. All the 7 pts were in shock on arrival. In these pts with heart injuries, all the wounds were in and near the Sauer's danger zone. In all pts, emergent thoracotomy was performed, and 5 pts could be saved (mortality 28.6%). As the risk factors, heart injuries, multiple injuries, and gunshot injuries were noticed with mortality of 28.6%, 23.8%, and 37.5%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Tracheal rupture in a patient with head and thoracic injuries].

A 49-year-old patient presented with cranioencephalic injuries including subdural hematoma and severe mass effect, facial and thoracic injuries with bilateral rib fractures but no parenchymatous lesions or extrapulmonary air. After surgical evacuation of the subdural hematoma, the patient entered the intensive care unit. Twenty-four hours later the patient pulled out the tubes, which were reinserted after signs of respiratory failure appeared. A series of clinical and radiological signs then followed, namely subcutaneous cervicothoracic emphysema, mediastinitis accompanied by hyperinsufflated balloon tamponade (pressures < 28 cmH2O). Tracheal rupture was suspected, but fibrebronchoscopy through the trachea revealed no damage. Surgical exploration 72 hours after admission confirmed high tracheal rupture near the pars membranacea. The damage was sutured, but sepsis with severe respiratory distress and mediastinitis led to death.

Brain Injuries↗
PubMed1996

IL-11 enhances survival and decreases TNF production after radiation-induced thoracic injury.

We hypothesized that IL-11 would protect against radiation-induced thoracic injury. To test this hypothesis, we compared the survival of rIL-11 and vehicle-treated control mice after 25 Gy of thoracic irradiation, and initiated studies to elucidate the mechanism of the observed protection. This dose of radiation killed 50% of the control mice during the first 2 wk after irradiation. In contrast, the s.c. administration of rIL-11 resulted in significant radioprotection with 89% of the rIL-11-treated animals surviving the study interval (p < 0.001). This radioprotection was at least partially specific for normal thoracic structures since rIL-11 did not alter the development or radiosensitivity of EMT6 tumor cells growing as lung metastases. TNF mRNA was not detected in normal lungs but was impressively induced after thoracic irradiation. Treatment with rIL-11 abrogated this increase. Parallel in vitro studies demonstrated that rIL-11 inhibits LPS and radiation-induced macrophage TNF protein production and mRNA accumulation. These studies demonstrate that rIL-11 reduces the mortality following thoracic irradiation, without enhancing the development or diminishing the radiosensitivity of pulmonary metastatic tumors. They also demonstrate that rIL-11 inhibits both radiation-induced TNF mRNA expression in vivo and macrophage TNF protein production and mRNA accumulation in vitro, suggesting that the radioprotective effects of rIL-11 may be mediated, at least in part, via the modulation of TNF production.

Animals↗
PubMed1977

[Thoracic injury and fat embolism].

The authors state that fat embolism occurs rather frequently following thoracic injuries. It is difficult to make a diagnosis because of the complexity of the symptoms. The correct evaluation of the characteristic clinical and laboratory signs arising after a period free of symptoms is essential. The authors outline the brief case history of a successfully treated patient, who recovered, owing to the use of the respirator in the intensive care unit.

Adult↗