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Canadian Respiratory Journal
Volume 2016, Article ID 3257846, 5 pages
http://dx.doi.org/10.1155/2016/3257846
Research Article

Factors Associated with ICU Admission following Blunt Chest Trauma

1Emergency Ward, Niguarda Hospital, Milan, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
2Emergency Ward, Azienda Ospedaliera Sant’Anna di Como, Via Ravona 19, 22020 Como, Italy
3Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università degli Studi di Milano, Via GB Grassi 74, 20157 Milano, Italy

Received 31 August 2016; Revised 10 October 2016; Accepted 27 October 2016

Academic Editor: Zhongheng Zhang

Copyright © 2016 Andrea Bellone et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF) and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1%) were admitted to intensive care unit (ICU) within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea () and the severity of trauma score () were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure.