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Invited Critique
May 2010

The Broken ChestComment on “Factors Associated With Survival Following Blunt Chest Trauma in Older Patients”

Author Affiliations

Author Affiliations: Departments of Surgery, Faulkner Hospital, Boston, Massachusetts.

Arch Surg. 2010;145(5):437-438. doi:10.1001/archsurg.2010.72

Harrington et al have described factors affecting survival following blunt chest trauma in patients older than 50 years. While a laudable attempt to pool retrospective data from 8 large trauma centers, the article raises numerous questions that unfortunately are incompletely answered.

Since its inception, the Advanced Trauma Life Support course has stressed flail chest with pulmonary contusion as 1 of 6 life-threatening chest injuries whose identification is mandatory in the primary survey of the injured patient.1 The authors collected information on this subset of patients and have inferred that prolonged intubation may have been a “surrogate marker” for pulmonary contusion. However, other than this, their analysis is largely silent about the effect of these more severe injuries on mortality. It is difficult to interpret the results of this study without knowing the mortality of their patients with flail chest with pulmonary contusion. Put another way, we know that these patients are at high risk in the first place, and if they were eliminated from the analysis, would the conclusions of the article remain the same?

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