Prognostic factors in flail-chest patients.

Objective: The records of 250 patients presenting with flail-chest injury in a level I trauma centre were reviewed and analysed in order to determine prognostic factors.

Methods: There were 250 consecutive trauma patients with flail chest, 183 men (73.2%) and 67 women (26.8%) ranging in age from 18 to 91 years, admitted to our hospital. The leading cause of injury was road traffic accident. One hundred and six patients (42.4%) were conservatively treated, while 117 (46.8%) needed thoracic drainage. Ventilatory assistance was used in 28 cases (11.2%). Only 19 (7.6%) required thoracotomy and/or laparotomy. The mortality rate reached 8.8%. Patients were divided into three groups: group I consisted of 105 patients (70/35) with an isolated flail chest (Injury Severity Score (ISS): 16); group II included 58 cases (48/10) with extrathoracic fractures (ISS: 25-30); and group III comprised 87 patients (65/22) with injuries to the brain or to thoracic or abdominal organs requiring thoracotomy and/or laparotomy (ISS: >40). Parameters such as age, sex, ISS, presence of extrathoracic fractures, haemopneumothorax and head injury as well as the need for mechanical support in an intensive care unit (ICU) and mortality were evaluated.

Results: The mortality rate in group III was higher compared to those of groups I and II (16% vs 3.8% and 6.9%, respectively) and the difference was found to be statistically significant. Laparotomy and thoracotomy affected mortality, while age, pneumothorax and head injury did not. Finally, mechanical support was used only in a few cases.

Conclusions: (1) ISS is the strongest predictor of outcome associated with increased mortality; and (2) mechanical support was not considered a necessity for the treatment of flail chest.