Journal of Trauma and Injury

  • 제33권2호
  • /
  • Pages.88-95
  • /
  • 2020
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지
DOI QR코드

DOI QR Code

Analysis of Aspiration Risk Factors in Severe Trauma Patients: Based on Findings of Aspiration Lung Disease in Chest Computed Tomography

  • Heo, Gyu Jin (Department of Emergency Medicine, Gil Medical Center) ;
  • Lee, Jungnam (Department of Traumatology, Gil Medical Center, Gachon University College of Medicine) ;
  • Choi, Woo Sung (Department of Emergency Medicine, Gil Medical Center) ;
  • Hyun, Sung Youl (Department of Traumatology, Gil Medical Center, Gachon University College of Medicine) ;
  • Cho, Jin-Seong (Department of Emergency Medicine, Gil Medical Center, Gachon University College of Medicine)
  • 투고 : 2020.04.28
  • 심사 : 2020.06.30
  • 발행 : 2020.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: The present study will identify risk factors for aspiration in severe trauma patients by comparing patients who showed a sign of aspiration lung disease on chest computed tomography (CT) and those who did not. Methods: We conducted a retrospective review of the Korean Trauma Data Bank between January 2014 and December 2019 in a single regional trauma center. The inclusion criteria were patients aged ≥18 years with chest CT, and who had an Injury Severity Score ≥16. Patients with Abbreviated Injury Scale (AIS)-chest score ≥1 and lack of medical records were excluded. General characteristics and patient status were analyzed. Results: 425 patients were included in the final analysis. There were 48 patients showing aspiration on CT (11.2%) and 377 patients showing no aspiration (88.7%). Aspiration group showed more endotracheal intubation in the ER (p=0.000) and a significantly higher proportion of severe Glasgow Coma Scale (GCS) (p=0.000) patients than the non-aspiration group. In AIS as well, the median AIS head score was higher in the aspiration group (p=0.046). Median oxygen saturation was significantly lower in the aspiration group (p=0.002). In a logistic regression analysis, relative to the GCS mild group, the moderate group showed an odds ratio (OR) for aspiration of 2.976 (CI, 1.024-8.647), and the severe group showed an OR of 5.073 (CI, 2.442-10.539). Conclusions: Poor mental state and head injury increase the risk of aspiration. To confirm for aspiration, it would be useful to perform chest CT for severe trauma patients with a head injury.

키워드

참고문헌

  1. Raghavendran K, Nemzek J, Napolitano LM, Knight PR. Aspiration-induced lung injury. Crit Care Med 2011;39;818-26. https://doi.org/10.1097/CCM.0b013e31820a856b
  2. Sharon M henry, Saud A Al Turki, Col MW Bowyer, Kimberly A Davis, Julie A Dunn, et al. Advanced trauma life support student course manual. 10th ed. Chicago (IL):American College of Surgeons;2018.
  3. McNicholl BP. The golden hour and prehospital trauma care. Injury 1994;25:251-4. https://doi.org/10.1016/0020-1383(94)90073-6
  4. Yates DW. Airway patency in fatal accidents. Br Med J 1997;2:1249-51. https://doi.org/10.1136/bmj.2.6097.1249
  5. Ottosson A. Aspiration and obstructed airways as the cause of death in 158 consecutive traffic fatalities. J Trauma 1985;25:538-40. https://doi.org/10.1097/00005373-198506000-00012
  6. Lockey DJ, Coats T, Parr MJ. Aspiration in severe trauma: a prospective study. Anesthesia 1999;54;1097-8. https://doi.org/10.1046/j.1365-2044.1999.00754.x
  7. Hu X, Lee JS, Pianosi PT, Ryu JH. Aspiration-related pulmonary syndromes. Chest 2015;147:815-23. https://doi.org/10.1378/chest.14-1049
  8. Marik PE. Pulmonary aspiration syndromes. Curr Opin Pulm Med 2011;17:148-54. https://doi.org/10.1097/MCP.0b013e32834397d6
  9. Benjamin E, Haltmeier T, Chouliaras K, Siboni S, Durso J, Inaba K, et al. Witnessed aspiration in trauma: frequent occurrence, rare morbidity--a prospective analysis. J Trauma Acute Care Surg 2015;79;1030-6; discussion 1036-7. https://doi.org/10.1097/TA.0000000000000704
  10. Fawcett VJ, Warner KJ, Cuschieri J, Copass M, Grabinsky A, Kwok H, et al. Pre-hospital aspiration is associated with increased pulmonary complications. Surg Infect (Larchmt) 2015;16;159-64. https://doi.org/10.1089/sur.2013.237
  11. McCoy CE, Chakravarthy B, Lotfipour S. Guidelines for field triage of injured patients: in conjunction with the morbidity and mortality weekly report published by the center for disease control and prevention. West J Emerg Med 2013;14:69-76. https://doi.org/10.5811/westjem.2013.1.15981
  12. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344:665-71. https://doi.org/10.1056/NEJM200103013440908
  13. Franquet T, Gimenez A, Roson N, Torrubia S, Sabate JM, Perez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics 2000;20:673-85. https://doi.org/10.1148/radiographics.20.3.g00ma01673
  14. Komiya K, Ishii H, Umeki K, Kawamura T, Okada F, Okabe E, et al. Computed tomography findings of aspiration pneumonia in 53 patients. Geriatr Gerotol Int 2013;13:580-5. https://doi.org/10.1111/j.1447-0594.2012.00940.x
  15. DiBardino DM, Wunderink RG. Aspiration pneumonia: a review of modern trends. J Crit Care 2015;30:40-8. https://doi.org/10.1016/j.jcrc.2014.07.011
  16. Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet 1996;348:123-4. https://doi.org/10.1016/S0140-6736(05)64630-2
  17. Moulton C, Pennycook AG. Relation between Glasgow Coma Score and cough reflex. Lancet 1994;343:1261-2. https://doi.org/10.1016/S0140-6736(94)92155-5
  18. Moulton C, Pennycook A, Makower R. Relation between Glasgow Coma Scale and the gag reflex. BMJ 1991;303:1240-1. https://doi.org/10.1136/bmj.303.6812.1240
  19. Blyth BJ, Bazarian JJ. Traumatic alterations in consciousness: traumatic Brain injury. Emerg Med Clin North Am 2010;28:571-94. https://doi.org/10.1016/j.emc.2010.03.003
  20. Nee PA, Hadfield JM, Yates DW, Faragher EB. Significance of vomiting after head injury. J Neurol Neurosurg Psychiatry 1999;66:470-3. https://doi.org/10.1136/jnnp.66.4.470
  21. Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 2009;373:1455-61. https://doi.org/10.1016/S0140-6736(09)60232-4
  22. Becker CD, Poletti PA. The trauma concept: the role of MDCT in the diagnosis and management of visceral injuries. Eur Radiol 2005;15(Suppl 4):D105-9. https://doi.org/10.1007/s10406-005-0122-9
  23. Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000-2005. Emerg Radiol 2006;13:25-30. https://doi.org/10.1007/s10140-006-0493-9
  24. Huber-Wagner S, Biberthaler P, Haberle S, Wierer M, Dobritz M, Rummeny E, et al. Whole-body CT in haemodynamically unstable severely injured patients--a retrospective, multicentre study. PLoS One 2013;8;e68880. https://doi.org/10.1371/journal.pone.0068880