Geriatric Skiers: Active But Still at Risk, a National Trauma Data Bank Study.

BACKGROUND: Downhill skiing accounts for a large portion of geriatric sport-related trauma. We assessed the national burden of geriatric versus nongeriatric ski trauma. MATERIALS AND METHODS: Adults presenting to level 1/2 trauma centers after ski-associated injuries from 2011 to 2015 were identified from the National Trauma Data Bank by ICD-9 code. We compared demographics, injury patterns, and outcomes between geriatric (age ≥65 y) and nongeriatric adult skiers (age 18-64 y). A multiple regression analysis assessed for risk factors associated with severe injury (Injury Severity Score >15). RESULTS: We identified 3255 adult ski trauma patients, and 16.7% (543) were geriatric. Mean ages for nongeriatric versus geriatric skiers were 40.8 and 72.1 y, respectively. Geriatric skiers more often suffered head (36.7 versus 24.3%, P < 0.0001), severe head (abbreviated injury scale score >3, 49.0 versus 31.5%, P < 0.0001) and thorax injuries (22.2 versus 18.1%, P = 0.03) as compared with nongeriatric skiers. Geriatric skiers were also more often admitted to the ICU (26.5 versus 14.9%, P < 0.0001), discharged to a facility (26.7 versus 11.6%, P < 0.0001), and suffered higher mortality rates (1.3 versus 0.4%, P = 0.004). Independent risk factors for severe injury included being male (OR: 1.68, CI: 1.22-2.31), helmeted (OR: 1.41, CI: 1.07-1.85), and having comorbidities (OR: 1.37, CI: 1.05-1.80). Geriatric age was not independently associated with severe injury. CONCLUSIONS: At level 1/2 trauma centers, geriatric age in ski trauma victims was associated with unique injury patterns, higher acuity, increased rates of facility care at discharge, and higher mortality as compared with nongeriatric skiers. Our findings indicate the need for specialized care after high impact geriatric ski trauma.

Severity assessment of accidents involving roadside trees based on occupant injury analysis.

The aims of this study were to achieve a quantitative assessment of the severity of accidents involving roadside trees on highways and to propose corresponding safety measures to reduce accident losses. This paper used the acceleration severity index (ASI), head injury criteria (HIC) and chest resultant acceleration (CRA) as indicators of occupant injuries and horizontal radii, vehicle departure speeds, tree diameters and roadside tree spacing as research variables to carry out bias collision tests between cars, trucks and trees by constructing a vehicle rigid body system and an occupant multibody system in PC-crash 10.0® simulation software. A total of 2,256 data points were collected. For straight and curved segments of highways, the occupant injury evaluation models of cars were fitted based on the CRA, and occupant injury evaluation models of trucks and cars were fitted based on the ASI. According to the Fisher optimal segmentation method, reasonable classification standards of severities of accidents involving roadside trees and the corresponding ASI and CRA thresholds were determined, and severity assessment methods for accidents involving roadside trees based on the CRA and ASI were provided. Additionally, a new index by which to evaluate the accuracy of the accident severity classification and the degree of misclassification was built and applied for the validity verification of the proposed severity assessment methods. A proportion of trucks was introduced to further improve the ASI evaluation model. For the same simulation conditions, the results show that driver chest injuries are more serious than driver head injuries and that the average ASI of cars is greater than that of trucks. The CRA and ASI have a positive linear correlation with the departure speed and a logarithmic correlation with the roadside tree diameters. The larger the spacing of roadside trees is and the smaller the horizontal radius is, the smaller the chance that a vehicle will experience a second collision and the lower the risk of occupant injury. In method validation, the evaluation results from two proposed severity assessment methods based on the CRA and ASI are consistent, and the degrees of misclassification are 4.65% and 4.26%, respectively, which verifies the accuracy of the methods proposed in this paper and confirms that the ASI can be employed as an effective index for evaluating occupant injuries in accidents involving roadside trees.

Assessment of Thoracic Response and Injury Risk Using the Hybrid III, THOR-M, and Post-Mortem Human Surrogates under Various Restraint Conditions in Full-Scale Frontal Sled Tests.

A total of 20 full-scale frontal sled tests were conducted using the Hybrid III (HIII), THOR-M and post-mortem human surrogates (PMHSs) to evaluate the thoracic biofidelity of the HIII and THOR-M under various belted restraint conditions. Each surrogate was tested under three belted restraint conditions: knee bolster, knee bolster and steering wheel airbag, and knee bolster airbag and steering wheel airbag. In order to assess the relative biofidelity of each ATD, external thoracic deflections were quantitatively compared between the ATDs and PMHSs using an objective rating metric. The HIII had slightly higher biofidelity than the THOR-M for the external thoracic deflections. Specifically, the THOR-M lower chest was more compliant compared to the other surrogates. However, the THOR-M exhibited expansion of the lower chest opposite belt loading, which was also observed to some degree in the PMHSs. The efficacy of the current injury risk prediction instrumentation and criteria were also evaluated for each surrogate. The THOR-M and its proposed injury risk criteria predicted the injuries observed in the PMHS tests better than the HIII. The PMHS injury criteria over-predicted the amount of chest deflection necessary to produce a severe injury and, consequently, under-predicted injury risk. The results of this study indicate that further testing should be performed to evaluate the biofidelity of the THOR-M thorax under more conditions. Furthermore, current thoracic injury risk criteria, which were developed using censored data, may not be effective at predicting injuries for all restraints and experimental conditions.

Assessment of Bilateral Thoracic Loading on the Near-Side Occupant Due to Occupant-to-Occupant Interaction in Vehicle Crash Tests.

OBJECTIVE: This study aims, by means of the WorldSID 50th percentile male, to evaluate thoracic loading and injury risk to the near-side occupant due to occupant-to-occupant interaction in combination with loading from an intruding structure. METHOD: Nine vehicle crash tests were performed with a 50th percentile WorldSID male dummy in the near-side (adjacent to the intruding structure) seat and a THOR or ES2 dummy in the far-side (opposite the intruding structure) seat. The near-side seated WorldSID was equipped with 6 + 6 IR-Traccs (LH and RH) in the thorax/abdomen enabling measurement of bilateral deflection. To differentiate deflection caused by the intrusion, and the deflection caused by the neighboring occupant, time history curves were analyzed. The crash tests were performed with different modern vehicles, equipped with thorax side airbags and inflatable curtains, ranging from a compact car to a large sedan, and in different loading conditions such as car-to-car, barrier, and pole tests. Lateral delta V based on vehicle tunnel acceleration and maximum residual intrusion at occupant position were used as a measurement of crash severity to compare injury measurements. RESULT: In the 9 vehicle crash tests, thoracic loading, induced by the intruding structure as well as from the far-side occupant, varied due to the size and structural performance of the car as well as the severity of the crash. Peak deflection on the thoracic outboard side occurred during the first 50 ms of the event. Between 70 to 150 ms loading induced by the neighboring occupant occurred and resulted in an inboard-side peak deflection and viscous criterion. In the tests where the target vehicle lateral delta V was below 30 km/h and intrusion less than 200 mm, deflections were low on both the outboard (20-40 mm) and inboard side (10-15 mm). At higher crash severities, delta V 35 km/h and above as well as intrusions larger than 350 mm, the inboard deflections (caused by interaction to the far-side occupant) were of the same magnitude or even higher (30-70 mm) than the outboard deflections (30-50 mm). CONCLUSION: A WorldSID 50th percentile male equipped with bilateral IR-Traccs can detect loading to the thorax from a neighboring occupant making injury risk assessment feasible for this type of loading. At crash severities resulting in a delta V above 35 km/h and intrusions larger than 350 mm, both the inboard deflection and VC resulted in high risks of Abbreviated Injury Scale (AIS) 3+ injury, especially for a senior occupant.

Radiographic and electrocardiography-gated noncontrast cardiac CT assessment of lead perforation: modality comparison and interobserver agreement.

BACKGROUND: Pacemaker or implantable cardioverter-defibrillator lead extraction may be required because of infection, malfunction, or breakage. The preprocedural identification of lead tip position may help ensure safe performance of the procedure. OBJECTIVE: To analyze the ability of chest radiography and CT imaging to characterize lead tip position and identify perforation in a population of patients who underwent lead extraction. METHODS: Among patients who underwent lead extraction between November 2008 and April 2011, a nonrandom subset of 50 patients with 116 leads was selected for retrospective analysis. All patients had undergone chest radiography and thin-section electrocardiography-gated noncontrast cardiac CT. Two radiologists independently evaluated the imaging studies, using oblique multiplanar image reconstruction techniques for the CT examinations. Beam hardening artifacts were graded (0-3). Likelihood of perforation on each imaging study was graded on a 5-point scale. RESULTS: Among 116 leads, 17 were identified as perforated on CT, 12 leads were equivocal, and 87 were not perforated. Interobserver agreement for CT perforation vs nonperforation was good (κ = 0.71); weighted kappa for the entire 5-point scale was moderate (κ = 0.54). Beam hardening artifacts were common, with a mean value of 2.1. The 2 observers identified perforation on chest radiography with an average sensitivity of 15% compared with CT. The 2 observers did not agree on any cases of chest radiographic perforation (κ = -0.1). CONCLUSION: Electrocardiography-gated noncontrast cardiac CT imaging with oblique multiplanar analysis can identify potential lead perforation with a moderate-to-good level of interobserver agreement. Chest radiography demonstrates poor sensitivity and interobserver agreement compared with CT.

Improving Hybrid III injury assessment in steering wheel rim to chest impacts using responses from finite element Hybrid III and human body model.

OBJECTIVE: The main aim of this study was to improve the quality of injury risk assessments in steering wheel rim to chest impacts when using the Hybrid III crash test dummy in frontal heavy goods vehicle (HGV) collision tests. Correction factors for chest injury criteria were calculated as the model chest injury parameter ratios between finite element (FE) Hybrid III, evaluated in relevant load cases, and the Total Human Model for Safety (THUMS). This is proposed to be used to compensate Hybrid III measurements in crash tests where steering wheel rim to chest impacts occur. METHODS: The study was conducted in an FE environment using an FE-Hybrid III model and the THUMS. Two impactor shapes were used, a circular hub and a long, thin horizontal bar. Chest impacts at velocities ranging from 3.0 to 6.0 m/s were simulated at 3 impact height levels. A ratio between FE-Hybrid III and THUMS chest injury parameters, maximum chest compression C max, and maximum viscous criterion VC max, were calculated for the different chest impact conditions to form a set of correction factors. The definition of the correction factor is based on the assumption that the response from a circular hub impact to the middle of the chest is well characterized and that injury risk measures are independent of impact height. The current limits for these chest injury criteria were used as a basis to develop correction factors that compensate for the limitations in biofidelity of the Hybrid III in steering wheel rim to chest impacts. RESULTS: The hub and bar impactors produced considerably higher C max and VC max responses in the THUMS compared to the FE-Hybrid III. The correction factor for the responses of the FE-Hybrid III showed that the criteria responses for the bar impactor were consistently overestimated. Ratios based on Hybrid III and THUMS responses provided correction factors for the Hybrid III responses ranging from 0.84 to 0.93. These factors can be used to estimate C max and VC max values when the Hybrid III is used in crash tests for which steering wheel rim to chest interaction occurs. CONCLUSIONS: For the FE-Hybrid III, bar impacts caused higher chest deflection compared to hub impacts, although the contrary results were obtained with the more humanlike THUMS. Correction factors were developed that can be used to correct the Hybrid III chest responses. Higher injury criteria capping limits for steering wheel impacts are acceptable. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Prospective assessment of patient morbidity from prone sacral positioning.

OBJECT: Sacrectomy positioning must balance surgical exposure, localization, associated operative procedures, and patient safety. Poor positioning may increase hemorrhage, risk of blindness, and skin breakdown. METHODS: The authors prospectively identified positioning-related morbidity in 17 patients undergoing 19 prone sacral procedures from September 2008 to August 2009 following institution of a standardized positioning protocol. Key elements include skull traction/head suspension, an open radiolucent frame, and wide draping for associated closure and reconstructive procedures. RESULTS: Tumors included 5 chordomas, 4 high-grade sarcomas, 1 chondrosarcoma, 2 presacral extradural myxopapillary ependymomas, and 5 others. Mean patient age was 49.9 years (range 17-74 years); mean body mass index was 27.6 kg/m(2) (range 19.3-43.9 kg/m(2)). Mean preoperative Braden skin integrity score was 21.1 (range 17-23). Average operative time was 501 minutes (range 158-1136 minutes). Prone surgery was a part of staged anterior/posterior resections in 8 patients. Localization was conducted using fluoroscopy in 13 patients and intraoperative CT in 4 patients. All imaging studies were successful. One patient developed a transient ulnar nerve palsy attributed to positioning. Three patients (two of whom were morbidly obese) developed Stage I pressure injuries to the chest and another developed Stage II pressure injury following a 1136-minute procedure. Morbidity was only observed in patients with morbid obesity or with procedures lasting in excess of 10 hours. CONCLUSIONS: A positioning protocol using head suspension on an open radiolucent frame facilitates oncological sacral surgery with reasonable patient morbidity. Morbid obesity and procedure times in excess of 10 hours are risk factors for positioning-related complications. To the authors' knowledge, this is the first report of surgical positioning morbidity in this patient population.

Assault induced stab injuries: epidemiology and actual treatment strategy.

OBJECTIVES: To investigate and analyse epidemiology, demographics and patterns of presentation of assault induced stab injuries in a main Belgian trauma centre. To evaluate surgical management, complications and postoperative follow-up of the stab wound victims. METHODS: One hundred and seventy assaulted patients, hospitalised because of stab injuries from January 2000 to June 2007 are studied retrospectively. RESULTS: Ninety-five percent of the assaults occurred on men and the mean age of the patients was 31.1 +/- 9.7 years. Ethnic minorities represent 77% of the patients hospitalised for assaults and 26.5% of all patients proved to be under toxic influence, predominantly from alcohol (21.8%). A decline of admissions of patients with stab injuries during the period 2002-2004 is recorded. However, the incidence doubled in the next two-year period. A weekend peak and circadian rhythm is apparent with more than 20% of the patients admitted between 4 and 6 am. The trunk is most frequently stabbed (54.5%) resulting in a laparotomy rate of 51%. One third of the patients who underwent thoraco-abdominal surgery revealed diaphragmatic injuries. Seventy-five percent of the patients left the hospital in a good condition while 2.4% had neuromuscular lesions. Two patients had serious vascular complications during follow-up. During the study period, no mortality was recorded. CONCLUSIONS: Stab wounds were recorded mainly in young and middle-aged men from ethnic minorities, whereas almost 27% were under the influence of drugs. A conservative approach was generally used resulting in a low laparotomy and thoracotomy rate without affecting mortality. Neuromuscular lesions are important long-term complications of stab injuries.

Sturdivan's formula revisited: MRI assessment of anterior chest wall thickness for injury risk prediction of blunt ballistic impact trauma.

BACKGROUND: The thickness and composition of the chest wall are important quantities in multiparametric trauma models for the assessment of injury severity due to blunt ballistic chest impact. While ballistic parameters of non-penetrating projectiles can routinely be measured with high accuracy, data on the thickness of the anterior chest wall is unreliable. Therefore, it is the aim of this work to provide data on the thickness and composition of the anterior chest wall based on MRI examinations of healthy volunteers and to compare these measurements with different empirical estimation rules for the chest wall thickness. METHODS: The study encompassed consecutive male patients from an ongoing population-based cohort study. Each subject underwent standardized whole-body MRI (1.5Tesla). Thickness of total chest wall (CWT) and of adipose tissue (AT) were measured by two independent readers at ten anatomic locations on two cross-sectional planes over the centre of the left ventricle and over the tracheal bifurcation. For each subject, chest wall thickness was estimated based on ten different empirical estimation rules and percent errors were calculated. RESULTS: The study encompassed 250 male volunteers (average age 55.5 years, range 21-84 years, SD 13.6 years). Mean intraclass correlation coefficient of the two readers was 0.90 (range 0.59-1.0, SD 0.08). Average CWT was 31.2mm (range 17.3-51.6mm, SD 5.8mm) while average thickness of AT was 13.1mm (range 3.6-26.7mm, SD 4.6mm). Relative adiposity was 0.41 on average (range 0.19-0.61, SD 0.09). There was significant correlation between CWT and body weight and between CWT and body mass index. Sturdivan's approximation formula showed strong correlation with the measured values (percent error 3.58%, SD 16.26%). CONCLUSION: In this population, Sturdivan's equation formula which is based on the individual's body weight provides valid approximation values for the chest wall thickness and may be used for the optimal design of protective devices and personal body armor as well as for the development of anthropomorphic based test methodologies.

Blunt Criterion trauma model for head and chest injury risk assessment of cal. 380 R and cal. 22 long blank cartridge actuated gundog retrieval devices.

BACKGROUND: Blunt ballistic impact trauma is a current research topic due to the widespread use of kinetic energy munitions in law enforcement. In the civilian setting, an automatic dummy launcher has recently been identified as source of blunt impact trauma. However, there is no data on the injury risk of conventional dummy launchers. It is the aim of this investigation to predict potential impact injury to the human head and chest on the basis of the Blunt Criterion which is an energy based blunt trauma model to assess vulnerability to blunt weapons, projectile impacts, and behind-armor-exposures. METHODS: Based on experimentally investigated kinetic parameters, the injury risk of two commercially available gundog retrieval devices (Waidwerk Telebock, Germany; Turner Richards, United Kingdom) was assessed using the Blunt Criterion trauma model for blunt ballistic impact trauma to the head and chest. RESULTS: Assessing chest impact, the Blunt Criterion values for both shooting devices were higher than the critical Blunt Criterion value of 0.37, which represents a 50% risk of sustaining a thoracic skeletal injury of AIS 2 (moderate injury) or AIS 3 (serious injury). The maximum Blunt Criterion value (1.106) was higher than the Blunt Criterion value corresponding to AIS 4 (severe injury). With regard to the impact injury risk to the head, both devices surpass by far the critical Blunt Criterion value of 1.61, which represents a 50% risk of skull fracture. Highest Blunt Criterion values were measured for the Turner Richards Launcher (2.884) corresponding to a risk of skull fracture of higher than 80%. CONCLUSION: Even though the classification as non-guns by legal authorities might implicate harmlessness, the Blunt Criterion trauma model illustrates the hazardous potential of these shooting devices. The Blunt Criterion trauma model links the laboratory findings to the impact injury patterns of the head and chest that might be expected.

Use of statewide hospital discharge data to evaluate the economic burden of neurocysticercosis in Los Angeles County (1991-2008).

Statewide hospital discharge data were used to assess the economic burden of neurocysticercosis in Los Angeles County (LAC) from 1991 through 2008. A neurocysticercosis hospitalization was defined as having a discharge diagnosis of cysticercosis in addition to convulsions, seizures, hydrocephalus, cerebral edema or cerebral cysts. This study identified 3,937 neurocysticercosis hospitalizations, with the number of annual hospitalizations remaining relatively unchanged over the study period (R(2) = 0.01), averaging 219 per year (range 180-264). The total of all neurocysticercosis hospitalization charges over the study period was $136.2 million, averaging $7.9 million per year. The average charge per patient was $37.6 thousand and the most common payment method was Medicaid (43.9%), followed by private insurance (24.5%). The average length of stay was 7.2 days. The substantial number of hospitalizations and significant economic cost underscore the importance of neurocysticercosis in LAC.

Three strikes--don't die of a broken heart.

There are multiple layers of complexity in prevention of vehicle related blunt traumatic aortic rupture (BTAR), many of which are enshrined within government policy and car design. We present a 'layers of protection analysis' (LOPA) based loosely on original work by Professor John Doyle, which describes these attempts to 'design out' the risk of BTAR following a vehicle collision. We have modified this approach to include a physiological dimension suggesting that this may be a factor in susceptibility to aortic injury following trauma. Understanding processes involved in BTAR following vehicle collisions is key to designing preventative processes.

Characteristics of pole impacts to side of passenger cars in European traffic accidents and assessment of injury mechanisms--analysis of German and UK in-depth data.

The national accident statistics demonstrate that the situation of passenger car side impacts is dominated by car-to-car accidents. Car side-to-pole impacts are relatively infrequent events but result in disproportionate rates of serious and fatal injuries when compared to those in car-to-car side impact. Hence their importance has been highlighted in recent studies. For the present study two approaches were undertaken to better understand the scenario of car-to-pole impacts in Germany. The German in-depth database GIDAS (German In-Depth-Accident Study) and the UK-based database CCIS (Co-operative Crash Injury Study) were used. The first part or the study is a statistical analysis of passenger car side-to-pole impacts to describe the characteristics and their importance relevant to other types of impact and to gain further knowledge about the main factors influencing the accident outcome. The second part contains a case-by-case review of passenger cars first registered 1998 and onwards to further investigate this type of impact, including regression analysis to assess the relationship between injury severity and pole impact relevant factors. The study uses a methodology that merges in-depth-accident data from different nations and shows how in-depth cases can be used for finding injury-related technical parameters like deformation pattern, load circumstances for impact locations, and directions on the vehicle for the assessment of current and prospective test regulations. Delta-v can be identified as the most significant influencing factor for MAIS, especially for injury severity for thr thorax and abdomen. The vast majority of severe and fatal injuries are in accidents involving damage to the passenger compartment. The depth of deformation has significant influence on the injury severity level of the extremities. The most frequent direction of impact in car side-to-pole impacts is perpendicular (90 degrees +/-15 degrees ).

[The anaesthetist's liability and bullfights]. / Responsabilité de l'anesthésiste et corrida.

Whether you are an aficionado or completely uninitiated, everyone has an opinion on bull-fighting. The bull-fighter is in constant risk of injury. A medical team made up of surgeons, anesthetists, emergency physicians and nurses remains present throughout the show. For the anaesthetist and surgeon, a wounded bullfighter is an emergency because the vital and functional prognosis are engaged. The team must act in conformity with normal practice and the Code of Medical Ethics because any lack of coordination between the practitioners is punishable by law in the same way as technical fault. Several specific aspects of this type of medical procedure should be highlighted: firstly, the legal restrictions within the corrida, and secondly, the nature of the medical team, which may be comprised of doctors normally based within a public health institution and others who practice in a private health establishment. The particularity of the situation reveals differences in the system of liability, and civil liability must be distinguished from administrative liability: both of these allow the victim to obtain compensation for harm caused, but the consequences of each are different according to doctor status. The fact that the anaesthetists frequently work on a voluntary and benevolent basis does not exonerate them from liability. Lastly, a question frequently addressed is whether or not the doctor is covered by his professional insurance when he is on ringside duty.

Road traffic accidents to african children: assessment of severity using the injury severity score (ISS).

The records of 324 children who were injured in road traffic accidents (RTA) between January 1992 and December 1995 were reviewed to determine the pattern, severity and outcome of their injuries. This represented 2% of all attendances at the emergency room. Pedestrians represented the largest group of patients. Head injuries were the most common injury, followed closely by limb trauma. Chest and abdominal trauma accounted for only 2.5 and 1.5% of patients, respectively. Eighty percent of abdominal injuries required a splenectomy, but most chest injuries were managed nonoperatively. In 306 children the ISS was 1-25 with no mortality but significant morbidity. Eighteen patients had an ISS of 26-54 with a 61% mortality rate (11 patients). The highest ISS were found in the group of patients who were passengers in a motor vehicle.

Hemoneumotorax traumático: servicio de salud metropolitano occidente 1988-1993 / Traumatic hemoneumothorax: western metropolitan health service 1998-1993

Se analizaron 274 historias clínicas de pacientes egresados de los servicios de cirugía y unidad de cuidados intensivos del Hospital San Juan de Dios, con diagnóstico de neumotórax, hemotórax y hemoneumotórax entre enero de 1988 y diciembre de 1993. Del total de casos, la mayoría correspondió a jóvenes de sexo masculino, con una alta consignación de estado de ebriedad al ingreso. La principal causa de lesión del espacio pleural, fueron las heridas por arma blanca inferidas en riñas y asaltos, siendo el hemoneumotórax la forma más frecuente de presentación. Se analiza la frecuencia de compromiso torácico y extratorácico asociados, su influencia en el tratamiento de complicaciones y pronóstico. Se destaca el uso de la pleurotomía, que pese a ser un procedimiento de baja complejidad, constituye la principal arma terapéutica en el manejo de las lesiones del espacio pleural

Traumatismos torácicos en el Servicio de Salud Metropolitano Occidente / Thoracic trauma at Servicio de Salud Metropolitano Occidente

La importancia de los traumatismos torácicos deriva de su alta frecuencia y de su eventual gravedad así como de sus complicaciones cardiovasculares y de sus repercusiones económicas y psicosociales. Se exponen los resultados del estudio retrospectivo de una serie de 359 pacientes con traumatismos torácicos, atendidos en el Hospital San Juan de Dios entre 1988 y 1993. En la casuística se analiza las principales causas de traumatismos torácicos fueron las agresiones y la riñas (83,6 por ciento) relacionadas con la ingesta de alcohol. Las heridas más frecuentes fueron las penetrantes torácicas (87,7 por ciento) con compromiso del espacio pleural, producidas mayoritariamente por armas blancas. Con respecto a tratamiento, en general, bastan medidas simples como la pleurotomía que fue practicada en el 85,7 por ciento de los casos. Sin embargo, el 38,7 por ciento de los pacientes con heridas penetrantes requirieron intervenciones quirúrgicas y el 13,7 por ciento de cirugía torácica. Los datos presentados confirman la frecuencia e importancia de los traumatismos torácicos, su relación con el alcoholismo; su mortalidad de 6,5 por ciento y sus repercusiones económicas tanto individuales y familiares como para el sistema de salud (16 días de hospitalización promedio y 38,7 de intervenciones quirúrgicas)

Chest trauma. Assessment, diagnosis, and management.

In the United States, trauma is the leading cause of death in people under 40 years of age. Chest trauma is a relatively common but potentially lethal injury and requires a high level of suspicion, rapid diagnosis, and appropriate therapy. Methods for the assessment, diagnosis, and treatment of chest trauma are discussed in this article.