THE IMPACT OF THE QUANTITY OF SKELETAL INJURY ON MORTALITY AND PULMONARY MORBIDITY

Objective: To determine if the quantity of skeletal injuries (and the tinting to fixation) increases the mortality or pulmonary morbidity in patients with and without chest injuries, Design: Retrospective analy sis of trauma registry, Statistical analysis with multiple logistic re gression and chi(2) analysis, Methods: Looking specifically at adult p atients (>16 years), skeletal injury was quantified by determining the presence or absence of a fracture in specific bod, regions (humeri, f orearm, femur, tibia, spine, and pelvis) for a maximum of 10 skeletal injuries, The timing of fixation for fractures was categorized as <24 hours, <48 hours, <72 hours, <5 days, >5 days, or no fixation, Chest i njuries and pulmonary morbidity were based on the accepted list of com plications reported in the literature, Results: Three groups were anal yzed according to the presence or absence of a chest or skeletal injur y: those without skeletal injury (group NSI, n = 59), those without ch est injuries (group SCI, n = 108), and those with both skeletal and ch est injuries (group B, n = 59) Pulmonary Complications: When II patien t groups (NCI, NSI, and B) were pooled, greater chest injury (p < 0.00 08, greater skeletal injury (p < 0.02), and delayed fixation (p < 0.04 ) were associated with increased risk of developing a pulmonary compli cation, In the group of patients without a chest injury (NCI), this ri sk was associated with greater head injury (p < 0.005) and greater ske letal injury (p < 0.04), whereas in the group without a skeletal injur y (NSI), only chest injury demonstrated significance (p < 0.05), When both skeletal and chest injuries acre present, greater head injury (p < 0.03) and fixation time (p < 0.033 increased the risk of developing a pulmonary complication, Mortality: With all patients pooled (NCI, B, and NSI), head injury (p < 0.02), abdominal injury (p < 0.012), and f ixation time (p < 0.01) were risk factors, In patients without a chest injury (NCI), none of the indexed variables acre associated with mort ality, In patients without a skeletal injury (NSI), greater head injur y (p < 0.01), greater chest injury (p < 0.01), and greater abdominal i njury (p < 0.01) were risk factors for mortality. When both chest and skeletal injuries were present (B), only head injury (p < 0.0003) was associated with mortality, The prevalence of mortality and pulmonary c omplications Here compared between groups NCI. NSI, and B, Group SCI h ad fewer pulmonary complications (p < 0.004) than the other groups (di fference not significant), When examining mortality, group NCI had les s mortality than groups NSI and B, Conclusion: The combination of skel etal and chest injuries does not seem to amplify the pulmonary morbidi ty and mortality compared with chest injury alone, The quantity of the skeletal injury and the time to fixation of structures affecting mobi lization seem to hare an effect on pulmonary morbidity and mortality. Better scientific studies on the effects of skeletal injury and timing to fixation in relation to pulmonary morbidity and mortality are requ ired.