Factors affecting prognosis of flail chest:report of 226 cases

Objective Flail chest is most often accompanied by significant underlying pulmonary parenchymal injuries and may constitute a life-threatening thoracic injury.In this study we evaluated the treatment modalities for flail chest depending on the effect of trauma localization on mortality and morbidity.Methods Between January 2006 and September 2009,226 patients(183 males/43 females) were treated for flail chest.Location of the trauma in the chest wall,mechanical ventilation support,prognosis and injury severity score(ISS) were recorded for all patients.Mechanical ventilation support was given in 142 patients(62.8%),and 96 of these 142 patients required subsequent tracheostomy.Internal fixation was used in 108 patients.Results The major cause of flail chest was a car crash in 167 of 226 patients(73.9%).Median ISS was 66.8 for all patients.The patients with flail chest who had bilateral costochondral separation(anterior chest location)(group I,n =83) had a significantly higher ISS than those with single-side posterolateral flail chest(group II,n =143;ISS:71/56;P=0.02).The need for mechanical ventilation support was also higher in the group with bilateral costochondral separation.Mortality was higher in group I than in group II(P=0.03).Patients with a cranial trauma and flail chest had a higher mortality(16%) than patients with only flail chest(no mortality).The mean ISS was 76 for patients with cranial trauma and flail chest and 57.1(P 0.01) for patients with only flail chest.Sepsis and subarachnoid bleeding were the major causes of mortality.The mean ISS was 55.3 for patients under the age of 55(n =135) whereas it was 70.3 in those aged 55 and over(n =91;P=0.032).Mortality in the older group was also higher(8.8% vs 0.7%;P=0.03).ConclusionEarly intubation and mechanical ventilation is of paramount importance in patients with flail chest.However,prolonged mechanical ventilation is associated with a poor outcome.Tracheotomy and frequent flexible bronchoscopy are an effective pulmonary toilet.Advanced age and accompanied cranial trauma was major risk factors for flail chest trauma mortality.Bilateral costochondral separation also increased the risk of mortality and the need for mechanical ventilation in patients with flail chest.