Assessing the Impact of Trauma Score, Mechanisms and Demographics on Chest Injury Outcomes 

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Background Chest traumas are a major cause of morbidity and mortality globally, often resulting from high-energy impacts like motor vehicle accidents, falls, crushing injuries, and penetrating injuries. These can lead to various injuries, including lung contusions and rib fractures, requiring urgent medical or surgical intervention. The injury severity and mechanism, along with factors such as age and gender, influence clinical outcomes. Methods This was a retrospective study of 525 patients with thoracic trauma presenting to a secondary-care public hospital from May 2022 to May 2024. Demographic profiles, diagnoses, radiological findings, and surgical procedures were recorded and analyzed using Binary and Multinomial Logistic Regression and Chi-square tests. Results Among 525 patients, 158 were female, and 367 were male. The most common trauma etiologies were falls (58.7%) and traffic accidents (22.7%). Rib fractures were the most frequent injury (67.2%), with older patients and females at higher risk. Concomitant injuries were present in 28% of cases, mainly in traffic accidents. Intensive care was required in 12.4% of cases, especially after post-resuscitation, crush traumas, and polytrauma. The Chest Trauma Score (CTS) correlated with the hospitalization, requirement for intensive care, hemothorax, pneumothorax, and concomitant injuries. Conclusion The mechanism of injury and age significantly impact injury extent in chest traumas. Falls and traffic accidents increase the risk of rib fractures, while older patients are at higher risk for hemothorax and rib fractures. An increased trauma score is related to concomitant injuries and the requirement for intensive care. These findings emphasize the importance of factoring in both the type of trauma and the age in patient management to provide appropriate treatment and prevent complications. chest trauma rib fractures trauma mechanisms age-related injury trauma outcomes Figures Figure 1 Figure 2 INTRODUCTION Chest traumas are described as a major cause of morbidity and mortality worldwide and usually occur as a result of high-energy trauma ( 1 ). It can occur due to a variety of reasons, including motor vehicle accidents, falls from heights, crushing injuries, and penetrating injuries ( 2 ). These traumas can cause a wide spectrum of injuries including lung contusions, rib fractures, hemothorax, pulmonary lacerations, and necessitate urgent medical and frequently surgical interventions ( 3 , 4 ). The pattern and severity of injury is directly related to the mechanism of the trauma. Motor vehicle accidents are often high-energy traumas that can affect multiple organ systems and cause serious injuries ( 5 , 6 ). Falls from heights are notably associated with rib fractures and vertebral injuries. Additionally, demographic factors such as age and gender may influence post-traumatic injury patterns and clinical outcomes ( 7 ). While decreased bone mineral density and limited cardiopulmonary reserve in older patients put this group at greater risk of serious complications, younger patients typically exhibit greater potential for recovery ( 8 ). Rapid and accurate assessment is vital in the management of chest trauma. Initial assessment should include physical examination, radiologic imaging, and, if necessary, surgical intervention to determine the extent of injury. Patient prognosis and treatment strategies can vary based on the cause of trauma and whether polytrauma is present ( 9 ). The aim of this study was to assess the impact of different trauma mechanisms and age groups on the extent of injury and prognosis in chest traumas. The study aimed to contribute to the development of more effective strategies in trauma management by investigating the relationship between patient demographics, injury mechanisms and clinical outcomes. PATIENTS AND METHODS In this study, patients who presented to the emergency department of a secondary public hospital and consulted to the thoracic surgeon between May 2022 and May 2024 were retrospectively examined. Patient Population : Out of the 689 patients consulted to thoracic surgery from the emergency department, 120 cases were excluded from the study: 11 cases underwent evacuating thoracentesis for pleural effusion, 57 received catheter thoracostomy for pleurisy, and 52 were managed with medical treatment for minimal pleural fluid. Additionally, 31 cases who were treated with tube thoracostomy due to spontaneous collapsed lungs and 13 cases who were treated with conservative approach with minimal pneumothorax (a total of 44 cases) were excluded. Remaining 525 cases with thoracic trauma were included in the study (Fig. 1 ). Data Collection Demographics, presenting complaints, diagnoses, radiological findings and surgical procedures performed for the 525 patients included in the study were recorded at the time of admission and retrospectively analyzed. Statistical Analysis Statistical analyses were performed using SPSS® for Windows version 25.0 (IBM, Chicago, IL, United States). Binary and Multinomial Logistic Regression Analysis was used to evaluate the effect of independent variables such as trauma etiology, gender, age, trauma score on injury extent and prognosis. Chi-square tests were used to determine the relationships between categorical variables such as gender, trauma mechanism and age groups. In statistical analyses, level of significance was considered as p < 0.05. Ethical Approval: The study was conducted with approval from the local ethics committee (Human Research Ethics Committee of XXX University, approval number: 2024/174, approval date: 01/07/2024) and patients' personal data were processed in accordance with confidentiality principles according to the Declaration of Helsinki and Patient Rights Regulation. Results Among 525 thorax trauma cases included in the study 158 were female and 367 were male. The most common trauma etiology was fall from height (58.7%), followed by car accidents (22.7%) and blunt force trauma (7.8%) (Table 1). The average age of the patients was 57 ± 18 years, with age distribution varying according to trauma mechanisms (Table 1). The highest average age was noted in cases involving penetrating injuries (62 years) and post-resuscitative cases (63 years), while the lowest average age was found in motorcycle accidents at 44 years. As a result of a higher rural population, 55% of chest trauma patients were from rural areas and 45% were from city centers (Table 1). Multinomial logistic regression analysis revealed that patients from outside the city had a higher incidence of falls compared to those from city centers (OR:6.08; 95% CI: 3.79 - 9.78; p<0.001). Contrary to that, penetrating injuries were more common in urban populations (OR:3.19; 95% CI: 1.13 - 9; p=0.028). Other trauma mechanisms did not present any difference. Rib fracture was the most common type of injury and detected in 67.2% of the patients. Incidence of rib fracture after motorcycle accidents, car accidents and fall were determined as 75%, 72.3% and 70.5% respectively (OR=2.36; %95 CI: 1.15 - 4.83; p=0.019). As the age of the patients increased, the risk of rib fractures increased significantly (OR=1.03; %95 CI: 1.01 - 1.05; p=0.002). The findings indicate that female gender confers a significant disadvantage in both the risk of rib fracture (OR=1.81; 95% CI: 1.05 - 3.12; p=0.032) and in the number of rib fractures detected (OR=1.16; 95% CI: 1.02 - 1.32; p=0.028). Concomitant injuries were found in 28% (n=147) of the total cases and were more common in car accidents (50.4%) and motorcycle accidents (50%)(OR=3.1; %95 CI: 1.8 - 5.3; p<0.,001). The most common concomitant injuries were vertebrae (39), sternum (27), clavicle (20), humerus (14), scapula (10), pelvis (10), femur (9) and radius (7) fractures. Additionally, intracranial hemorrhage was observed in seven cases, spleen rupture in six cases, and liver laceration in two cases. Among cases with additional injuries, 26.5% were admitted to intensive care units (ICU). In contrast, this percentage was significantly lower at 6.9% for cases with isolated chest trauma (p < 0.001). Eighteen cases suffering from concomitant injury were referred to advanced medical centers due to the need for a higher level of care or surgery. One of these cases underwent surgical treatment for flail chest, while the others were referred due to polytrauma. Hemothorax was seen in 13.5% of the total patient population. The highest hemothorax ratio was found in penetrating injuries (23.5%) and crushing traumas (38.9%). As age increased, there was an observed trend where the risk of hemothorax increased to the extent approaching statistical significance (OR=1.04; 95% CI: 1.00 - 1.08; p=0.052). Among all cases, the overall pneumothorax incidence was 17.5%, with the highest rates observed in penetrating injuries (70.6%) and post-resuscitative cases (60%). In penetrating injuries, the risk of pneumothorax was significantly higher (OR=2.6; %95 CI: 1.5 - 4.5; p<0.001). Pneumoderma developed in 5.5% of the cases and was significantly more frequent in post-resuscitative cases (40%) and patients with penetrating injuries (23.5%)(OR=3.8; %95 CI: 1.9 - 7.6; p<0.001). The rate of intensive care admission requirement in cases with thoracic trauma was 12.4%. All post-resuscitative cases required intensive care due to their nature. In addition, the prevalence of intensive care admission was significantly higher in crush traumas (OR=4.2; %95 CI: 2.3 - 7.8; p<0.001). Moreover, 39% of the cases evaluated as multitrauma required intensive care. This rate was statistically significantly higher than those with isolated thoracic traumas (OR=4.8; %95 CI: 2.8 - 8.4; p<0.001). Falls and traffic collisions presented the highest risk for rib fractures and concomitant injuries. While 50.4% of traffic accident cases involved additional injuries, this rate was 21.1% for cases involving falling from height (OR=1.6; %95 CI: 1.1 - 2.4; p=0.027). In the multinomial logistic regression analysis of cases who fell, a linear association was found between height and incidence of rib fracture (OR: 4.34; %95 CI: 2.42-7.78 ve p<0.001)(Table 2). In addition, it was found that the number of fractured ribs was significantly higher in cases falling from heights. (OR: 3.92; %95 CI: 2.4-6.42 ve p<0.001). It has been observed that the chance of having rib fractures increases with age (OR: 2.48; %95 CI: 1.398-4.384 ve p=0.002) and risk of hemothorax in falls increased (OR: 1.04; %95 CI: 1-1.08 ve p=0.052). No significant difference was found in terms of incidence of fractured ribs considering patients’ gender. (OR: 1.69; %95 CI: 0.96-2.97 ve p=0.067)(Table 2). A significant relationship was found between the number of fractured ribs and additional injuries. Higher number of rib fractures was correlated with concomitant injuries such as fractures of the vertebrae, sternum, clavicle, humerus and femur (OR: 1.27; %95 CI: 1.01-1.58 ve p=0.04). We constructed several hazard regression models with prognosis and injury indicators (intensive care unit admission, concomitant injury, hemothorax and pneumothorax) separately to determine the correlations with the chest trauma score (CTS), a scoring system for determining the impact of injury through calculating certain parameters (Table 3). The receiver operating characteristic (ROC) curve analysis demonstrated a significant relationship between CTS and the probability of hospitalization and ICU admission (p<0.001). Hemothorax was observed more frequently with increased CTS, also with statistical significance (p<0.001). Although the incidence of concomitant injuries, pneumothorax and chest tube insertion had lower area under the curve (AUC) values, there was a significance (p<0.001) (Figure 2). The length of hospital stay (LOS) of patients with CTS greater than 7 was 6 ± 3 days. Patients with lower scores had significantly shorter LOS at 3 ± 1 days (p=0.004). Discussion The findings of this study distinctively revealed the effects of the mechanism of trauma and age of the patients on the extent of injury in chest traumas. In particular, it has been shown that falling and traffic accidents increase the risk of rib fracture. The correlation between height and rib fractures in cases of falls from heights underscores the importance of thorough evaluation to accurately diagnose rib fractures in these patients. The results we obtained emphasize the necessity of detailed handling and radiological investigations of trauma patients during their initial evaluation in the emergency department, in accordance with the literature ( 6,8 ). Klempka et al suggested that superficial injuries like skin lesions are associated with a higher chance of internal damage and require computed tomography for further evaluation ( 10 ). Older age groups demonstrating a higher risk in terms of rib fracture and hemothorax showed that elderly patients who fell should be evaluated more carefully. With the increase in age, the decrease in bone density and the increase in the risk of fracture after falling may cause more serious injuries in this patient group ( 11,12 ). Therefore, a more comprehensive assessment in elderly patients is important for the prevention of possible complications ( 8,13 ). Although there is no significant difference in the distribution of trauma types and the incidence of concomitant injuries based on gender, the higher rate of rib fractures and greater number of fractured ribs in the female population after chest trauma should be taken into consideration during the initial evaluation. Post-traumatic recovery processes and complication risks may differ and this should be reflected in clinical management ( 7 ). The higher probability of concomitant trauma in traffic accidents indicates that a comprehensive assessment should be made in such traumas. Traffic collision victims should be evaluated with physical examination and detailed imaging for accompanying injuries such as vertebra, sternum and clavicle fractures ( 14,15 ). The complexity of the injury mechanism in these cases and the effects of high-energy trauma require a multidisciplinary approach ( 16 ). In addition, it should be remembered that polytrauma cases with additional injury are more likely to need intensive care and advanced interventions ( 17,18 ). The Chest Trauma Score (CTS) was developed by Pressley et al. in order to predict the outcome of chest traumas ( 19 ). This scoring system includes parameters such as pulmonary contusion, age, and the side and number of rib fractures. Final score ranges between 2-12, while CTS greater than 7 or 8 is associated with higher risk of mortality and ICU admission. Chen et al validated CTS with a retrospective study involving 1,361 trauma patients and suggested that scores of at least 5 were associated with worse patient outcomes ( 20 ). Our study results are consistent with the literature. We found that higher CTS scores were associated with higher probability of hospitalization and ICU admission and longer hospital stay. Sinop was reported to be the city with the highest median age with 43 in Türkiye. Although latest population statistics indicate an increase in urban residents, the majority of the population lives in rural areas (21). Our trauma patients’ residences were consistent with this statistic and 55% were from outside the city. As a result of different economic and social dynamics such as agriculture and forestry, falling from height (tree, dome etc.) was more common in this population. This study provides important clues for the management of trauma cases in thoracic surgery emergency departments. Careful evaluation of patients with high-risk trauma mechanisms such as falls and traffic accidents is critical for preventing probable complications and determining appropriate treatment strategies ( 14 ). Understanding the impact of factors such as trauma mechanism and age on injury extent allows for more targeted and effective interventions in trauma management. Limitation Our study consisted of a patient population from a regional secondary care hospital in a city with lower criminal incidents and higher farmer and gardener population ratio than the rest of the country. Therefore the percentage of penetrating injury cases was significantly low, while falls from heights, such as fruit trees, might be found as more common. This affects the prevalence of trauma etiologies. However, the endpoint of this study was independent of this factor, as we focused on evaluating specific risk factors and their association with trauma outcomes. Conclusion In conclusion, the mechanism of trauma and age have a significant effect on the extent of injury in chest trauma. While falls and road traffic accidents increase the risk of rib fractures, the older age group is at higher risk for hemothorax and rib fractures. Increased trauma score was associated with concomitant trauma and the need for intensive care. These findings highlight important points to consider in the evaluation of trauma patients. Factors such as trauma type and age should be taken into account in the management of trauma patients in order to provide patients with the right treatment options and to prevent complications. A detailed and meticulous approach should be adopted in the acute management of thoracic traumas. Declarations Author Contribution İ.S. and İ.S. designed the study. İ.S. N.S.E. collected data. N.S.E. and K.Ö. reviewed literature. İ.S. made the analysis. İ.S. and K.Ö. wrote the main manuscript. İ.S. prepared figures, made critical review and supervised the study. All authors reviewed the manuscript. Conflict of Interest: None to declare References Battle C, Cole E, Whelan R, et al. Scoping review of the literature to ascertain how the STUMBL Score clinical prediction model is used to manage patients with blunt chest wall trauma in emergency care. Injury . 2023;54:110796. Çınar E, İnan K, Yıldız ÖÖ. Clinical analysis with trauma scoring in blunt thoracic trauma. Kafkas J Med Sci . 2021;11:208–213. Martin TJ, Eltorai AS, Dunn R, et al. Clinical management of rib fractures and methods for prevention of pulmonary complications: A review. Injury . 2019;50:1159–1165. Bouzat P, Raux M, David JS, et al. Chest trauma: First 48hours management. Anaesth Crit Care Pain Med . 2017;36:135–145. Benhamed A, Ndiaye A, Emond M, et al. Road traffic accident-related thoracic trauma: Epidemiology, injury pattern, outcome, and impact on mortality-A multicenter observational study. 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Access address: https://data.tuik.gov.tr/Bulten/Index?p=Adrese-Dayali-Nufus-Kayit-Sistemi-Sonuclari-2023-49684 Tables Table 1: Distribution and percentage of demographics, trauma types and management Parameters n % Gender Male 367 69.9 Femal 158 30.1 Age Mean 57 Standard deviation 18 Median 59 Residence City center 236 45.0 Rural areas 289 55.0 Trauma type Fall 308 58.7 Car accident 119 22.7 Blunt force trauma 41 7.8 Motorcycle accident 12 2.3 Penetrating 17 3.2 Crush 18 3.4 Post-resuscitation 5 1.0 Other 5 1.0 Intervention Conservative 458 87.2 Chest tube 62 11.8 Thoracic surgery 5 1.0 Management Hospitalization 125 23.8 Intensive care unit admission 65 12.4 Referred to another facility 18 3.4 Referred to outpatient clinic 317 60.4 Table 2: Multinomial logistic regression analysis of factors increasing the risk of rib fractures in patients who fall B Standard Error Odds Ratio 95% Confidence Interval p Value Gender 0.56 0.287 1.69 0.963 - 2.967 0.067 Age 0.907 0.292 2.476 1.398 - 4.384 0.002 Height 1.468 0.298 4.34 2.42 - 7.781 <0.001 Table 3: Chest trauma scoring (CTS) system Parameter Score Parameter Score Age <45 1 65 3 >5 Rib fracture 3 Pulmonary contusion Bilateral rib fracture None 0 No 0 Unilateral minor 1 Yes 2 Unilateral major 2 Bilateral minor 3 Bilateral major 4 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5334682","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":376309764,"identity":"f041284c-f4be-497b-b670-8dd1a8790e72","order_by":0,"name":"İsmail Sarbay","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBACNhDB2MDAwA9iJBSQokWyAaTFgFirQFoMDoBYxGjh4z/+8HPlDrvEzedXJ354YMAgzy92gIDDJHKMJc+eSU7cduPtZgmgwwxnzk4gpIWHQbKxjRmo5ewGkJYEg9uEtPAff/yzsa0+cfOMs5t/EKeFIcEMaMvhxA38vduItEUix8yy8cxx4xk3eLdZJBhIEPaLfP/xxzcbd1TL9vef3XzzR4WNPL80AS0w4NggAVYpQZxyELBn4D9AvOpRMApGwSgYWQAAWKNGIzVX2OgAAAAASUVORK5CYII=","orcid":"","institution":"Sinop Ataturk Public Hospital","correspondingAuthor":true,"prefix":"","firstName":"İsmail","middleName":"","lastName":"Sarbay","suffix":""},{"id":376309765,"identity":"0f77c5c9-fbc1-40eb-a8cc-16441ebcbe20","order_by":1,"name":"Kıvanç Öncü","email":"","orcid":"","institution":"Sinop Ataturk Public Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kıvanç","middleName":"","lastName":"Öncü","suffix":""},{"id":376309766,"identity":"d873fe28-5e7f-4c91-a0a3-5e92f485ccaa","order_by":2,"name":"Nurullah Sait Esme","email":"","orcid":"","institution":"Sinop Ataturk Public Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nurullah","middleName":"Sait","lastName":"Esme","suffix":""},{"id":376309768,"identity":"90faf074-7ec3-471e-b4e5-4250a7cf841e","order_by":3,"name":"İbrahim Sarbay","email":"","orcid":"","institution":"Gaziosmanpaşa Eğitim Ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"İbrahim","middleName":"","lastName":"Sarbay","suffix":""}],"badges":[],"createdAt":"2024-10-25 21:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5334682/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5334682/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69441083,"identity":"abaa1d33-076f-4ffd-9a4d-4c337f7ddc40","added_by":"auto","created_at":"2024-11-20 11:20:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78577,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5334682/v1/4ee0ab84c9424da4f09e59f8.png"},{"id":69441084,"identity":"ad0fd0b4-a32d-42f1-85a3-c362b20843b7","added_by":"auto","created_at":"2024-11-20 11:20:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":869580,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves were used to evaluate the predictive value of chest trauma score for injury and condition probabilities. The AUC value corresponding to each curve and its confidence interval are marked in the lower right. (a) ROC curves for hospitalization prediction; (b) ROC curves for intensive care unit admission prediction; (c) ROC curve for concomitant injury prediction; (d) ROC curve for chest tube insertion prediction; (e) ROC curve for pneumothorax prediction; (f) ROC curve for hemothorax prediction.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5334682/v1/f241c4d234f51633cac7c41e.png"},{"id":70564438,"identity":"ffe11b3b-4357-4e3e-9905-4f66861bbcd3","added_by":"auto","created_at":"2024-12-04 12:31:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1346253,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5334682/v1/c8108bf0-60bc-45cf-8a38-036bcaa06b54.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":" Assessing the Impact of Trauma Score, Mechanisms and Demographics on Chest Injury Outcomes ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eChest traumas are described as a major cause of morbidity and mortality worldwide and usually occur as a result of high-energy trauma (\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e). It can occur due to a variety of reasons, including motor vehicle accidents, falls from heights, crushing injuries, and penetrating injuries (\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e). These traumas can cause a wide spectrum of injuries including lung contusions, rib fractures, hemothorax, pulmonary lacerations, and necessitate urgent medical and frequently surgical interventions (\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003eThe pattern and severity of injury is directly related to the mechanism of the trauma. Motor vehicle accidents are often high-energy traumas that can affect multiple organ systems and cause serious injuries (\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e). Falls from heights are notably associated with rib fractures and vertebral injuries. Additionally, demographic factors such as age and gender may influence post-traumatic injury patterns and clinical outcomes (\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e). While decreased bone mineral density and limited cardiopulmonary reserve in older patients put this group at greater risk of serious complications, younger patients typically exhibit greater potential for recovery (\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003eRapid and accurate assessment is vital in the management of chest trauma. Initial assessment should include physical examination, radiologic imaging, and, if necessary, surgical intervention to determine the extent of injury. Patient prognosis and treatment strategies can vary based on the cause of trauma and whether polytrauma is present (\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003eThe aim of this study was to assess the impact of different trauma mechanisms and age groups on the extent of injury and prognosis in chest traumas. The study aimed to contribute to the development of more effective strategies in trauma management by investigating the relationship between patient demographics, injury mechanisms and clinical outcomes.\u003c/p\u003e"},{"header":"PATIENTS AND METHODS","content":"\u003cp\u003eIn this study, patients who presented to the emergency department of a secondary public hospital and consulted to the thoracic surgeon between May 2022 and May 2024 were retrospectively examined.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePatient Population\u003c/b\u003e: Out of the 689 patients consulted to thoracic surgery from the emergency department, 120 cases were excluded from the study: 11 cases underwent evacuating thoracentesis for pleural effusion, 57 received catheter thoracostomy for pleurisy, and 52 were managed with medical treatment for minimal pleural fluid. Additionally, 31 cases who were treated with tube thoracostomy due to spontaneous collapsed lungs and 13 cases who were treated with conservative approach with minimal pneumothorax (a total of 44 cases) were excluded. Remaining 525 cases with thoracic trauma were included in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Collection\u003c/strong\u003e \u003cp\u003eDemographics, presenting complaints, diagnoses, radiological findings and surgical procedures performed for the 525 patients included in the study were recorded at the time of admission and retrospectively analyzed.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e \u003cp\u003eStatistical analyses were performed using SPSS\u0026reg; for Windows version 25.0 (IBM, Chicago, IL, United States). Binary and Multinomial Logistic Regression Analysis was used to evaluate the effect of independent variables such as trauma etiology, gender, age, trauma score on injury extent and prognosis. Chi-square tests were used to determine the relationships between categorical variables such as gender, trauma mechanism and age groups. In statistical analyses, level of significance was considered as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eThe study was conducted with approval from the local ethics committee (Human Research Ethics Committee of XXX University, approval number: 2024/174, approval date: 01/07/2024) and patients\u0026apos; personal data were processed in accordance with confidentiality principles according to the Declaration of Helsinki and Patient Rights Regulation.\u003c/p\u003e\n"},{"header":"Results","content":"\u003cp\u003eAmong 525 thorax trauma cases included in the study 158 were female and 367 were male. The most common trauma etiology was fall from height (58.7%), followed by car accidents (22.7%) and blunt force trauma (7.8%) (Table 1).\u003c/p\u003e\n\u003cp\u003eThe average age of the patients was 57 \u0026plusmn; 18 years, with age distribution varying according to trauma mechanisms (Table 1). The highest average age was noted in cases involving penetrating injuries (62 years) and post-resuscitative cases (63 years), while the lowest average age was found in motorcycle accidents at 44 years.\u003c/p\u003e\n\u003cp\u003eAs a result of a higher rural population, 55% of chest trauma patients were from rural areas and 45% were from city centers (Table 1). Multinomial logistic regression analysis revealed that patients from outside the city had a higher incidence of falls compared to those from city centers (OR:6.08; 95% CI: 3.79 - 9.78; p\u0026lt;0.001). Contrary to that, penetrating injuries were more common in urban populations (OR:3.19; 95% CI: 1.13 - 9; p=0.028). Other trauma mechanisms did not present any difference.\u003c/p\u003e\n\u003cp\u003eRib fracture was the most common type of injury and detected in 67.2% of the patients. Incidence of rib fracture after motorcycle accidents, car accidents and fall were determined as 75%, 72.3% and 70.5% respectively (OR=2.36; %95 CI: 1.15 - 4.83; p=0.019). As the age of the patients increased, the risk of rib fractures increased significantly (OR=1.03; %95 CI: 1.01 - 1.05; p=0.002). The findings indicate that female gender confers a significant disadvantage in both the risk of rib fracture (OR=1.81; 95% CI: 1.05 - 3.12; p=0.032) and in the number of rib fractures detected (OR=1.16; 95% CI: 1.02 - 1.32; p=0.028).\u003c/p\u003e\n\u003cp\u003eConcomitant injuries were found in 28% (n=147) of the total cases and were more common in car accidents (50.4%) and motorcycle accidents (50%)(OR=3.1; %95 CI: 1.8 - 5.3; p\u0026lt;0.,001). The most common concomitant injuries were vertebrae (39), sternum (27), clavicle (20), humerus (14), scapula (10), pelvis (10), femur (9) and radius (7) fractures. Additionally, intracranial hemorrhage was observed in seven cases, spleen rupture in six cases, and liver laceration in two cases.\u003c/p\u003e\n\u003cp\u003eAmong cases with additional injuries, 26.5% were admitted to intensive care units (ICU). In contrast, this percentage was significantly lower at 6.9% for cases with isolated chest trauma (p \u0026lt; 0.001). Eighteen cases suffering from concomitant injury were referred to advanced medical centers due to the need for a higher level of care or surgery. One of these cases underwent surgical treatment for flail chest, while the others were referred due to polytrauma.\u003c/p\u003e\n\u003cp\u003eHemothorax was seen in 13.5% of the total patient population. The highest hemothorax ratio was found in penetrating injuries (23.5%) and crushing traumas (38.9%). As age increased, there was an observed trend where the risk of hemothorax increased to the extent approaching statistical significance (OR=1.04; 95% CI: 1.00 - 1.08; p=0.052).\u003c/p\u003e\n\u003cp\u003eAmong all cases, the overall pneumothorax incidence was 17.5%, with the highest rates observed in penetrating injuries (70.6%) and post-resuscitative cases (60%). In penetrating injuries, the risk of pneumothorax was significantly higher (OR=2.6; %95 CI: 1.5 - 4.5; p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003ePneumoderma developed in 5.5% of the cases and was significantly more frequent in post-resuscitative cases (40%) and patients with penetrating injuries (23.5%)(OR=3.8; %95 CI: 1.9 - 7.6; p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eThe rate of intensive care admission requirement in cases with thoracic trauma was 12.4%. All post-resuscitative cases required intensive care due to their nature. In addition, the prevalence of intensive care admission was significantly higher in crush traumas (OR=4.2; %95 CI: 2.3 - 7.8; p\u0026lt;0.001). Moreover, 39% of the cases evaluated as multitrauma required intensive care. This rate was statistically significantly higher than those with isolated thoracic traumas (OR=4.8; %95 CI: 2.8 - 8.4; p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eFalls and traffic collisions presented the highest risk for rib fractures and concomitant injuries. While 50.4% of traffic accident cases involved additional injuries, this rate was 21.1% for cases involving falling from height (OR=1.6; %95 CI: 1.1 - 2.4; p=0.027).\u003c/p\u003e\n\u003cp\u003eIn the multinomial logistic regression analysis of cases who fell, a linear association was found between height and incidence of rib fracture (OR: 4.34; %95 CI: 2.42-7.78 ve p\u0026lt;0.001)(Table 2). In addition, it was found that the number of fractured ribs was significantly higher in cases falling from heights. (OR: 3.92; %95 CI: 2.4-6.42 ve p\u0026lt;0.001). It has been observed that the chance of having rib fractures increases with age (OR: 2.48; %95 CI: 1.398-4.384 ve p=0.002) and risk of hemothorax in falls increased (OR: 1.04; %95 CI: 1-1.08 ve p=0.052). No significant difference was found in terms of incidence of fractured ribs considering patients\u0026rsquo; gender. (OR: 1.69; %95 CI: 0.96-2.97 ve p=0.067)(Table 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA significant relationship was found between the number of fractured ribs and additional injuries. Higher number of rib fractures was correlated with concomitant injuries such as fractures of the vertebrae, sternum, clavicle, humerus and femur (OR: 1.27; %95 CI: 1.01-1.58 ve p=0.04).\u003c/p\u003e\n\u003cp\u003eWe constructed several hazard regression models with prognosis and injury indicators (intensive care unit admission, concomitant injury, hemothorax and pneumothorax) separately to determine the correlations with the chest trauma score (CTS), a scoring system for determining the impact of injury through calculating certain parameters (Table 3). The receiver operating characteristic (ROC) curve analysis demonstrated a significant relationship between CTS and the probability of hospitalization and ICU admission (p\u0026lt;0.001). Hemothorax was observed more frequently with increased CTS, also with statistical significance (p\u0026lt;0.001). Although the incidence of concomitant injuries, pneumothorax and \u0026nbsp;chest tube insertion had lower area under the curve (AUC) values, there was a significance (p\u0026lt;0.001) (Figure 2).\u003c/p\u003e\n\u003cp\u003eThe length of hospital stay (LOS) of patients with CTS greater than 7 was 6 \u0026plusmn; 3 days. Patients with lower scores had significantly shorter LOS at 3 \u0026plusmn; 1 days (p=0.004).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study distinctively revealed the effects of the mechanism of trauma and age of the patients on the extent of injury in chest traumas. In particular, it has been shown that falling and traffic accidents increase the risk of rib fracture. The correlation between height and rib fractures in cases of falls from heights underscores the importance of thorough evaluation to accurately diagnose rib fractures in these patients.\u003c/p\u003e\n\u003cp\u003eThe results we obtained emphasize the necessity of detailed handling and radiological investigations of trauma patients during their initial evaluation in the emergency department, in accordance with the literature (\u003csup\u003e6,8\u003c/sup\u003e). Klempka et al suggested that superficial injuries like skin lesions are associated with a higher chance of internal damage and require computed tomography for further evaluation (\u003csup\u003e10\u003c/sup\u003e).\u003c/p\u003e\n\u003cp\u003eOlder age groups demonstrating a higher risk in terms of rib fracture and hemothorax showed that elderly patients who fell should be evaluated more carefully. With the increase in age, the decrease in bone density and the increase in the risk of fracture after falling may cause more serious injuries in this patient group (\u003csup\u003e11,12\u003c/sup\u003e). Therefore, a more comprehensive assessment in elderly patients is important for the prevention of possible complications (\u003csup\u003e8,13\u003c/sup\u003e).\u003c/p\u003e\n\u003cp\u003eAlthough there is no significant difference in the distribution of trauma types and the incidence of concomitant injuries based on gender, the higher rate of rib fractures and greater number of fractured ribs in the female population after chest trauma should be taken into consideration during the initial evaluation. Post-traumatic recovery processes and complication risks may differ and this should be reflected in clinical management (\u003csup\u003e7\u003c/sup\u003e).\u003c/p\u003e\n\u003cp\u003eThe higher probability of concomitant trauma in traffic accidents indicates that a comprehensive assessment should be made in such traumas. Traffic collision victims should be evaluated with physical examination and detailed imaging for accompanying injuries such as vertebra, sternum and clavicle fractures (\u003csup\u003e14,15\u003c/sup\u003e). The complexity of the injury mechanism in these cases and the effects of high-energy trauma require a multidisciplinary approach (\u003csup\u003e16\u003c/sup\u003e). In addition, it should be remembered that polytrauma cases with additional injury are more likely to need intensive care and advanced interventions (\u003csup\u003e17,18\u003c/sup\u003e).\u003c/p\u003e\n\u003cp\u003eThe Chest Trauma Score (CTS) was developed by Pressley et al. in order to predict the outcome of chest traumas (\u003csup\u003e19\u003c/sup\u003e). This scoring system includes parameters such as pulmonary contusion, age, and the side and number of rib fractures. Final score ranges between 2-12, while CTS greater than 7 or 8 is associated with higher risk of mortality and ICU admission. Chen et al validated CTS with a retrospective study involving 1,361 trauma patients and suggested that scores of at least 5 were associated with worse patient outcomes (\u003csup\u003e20\u003c/sup\u003e). Our study results are consistent with the literature. We found that higher CTS scores were associated with higher probability of hospitalization and ICU admission and longer hospital stay.\u003c/p\u003e\n\u003cp\u003eSinop was reported to be the city with the highest median age with 43 in T\u0026uuml;rkiye. Although latest population statistics indicate an increase in urban residents, the majority of the population lives in rural areas (21). Our trauma patients\u0026rsquo; residences were consistent with this statistic and 55% were from outside the city. As a result of different economic and social dynamics such as agriculture and forestry, falling from height (tree, dome etc.) was more common in this population.\u003c/p\u003e\n\u003cp\u003eThis study provides important clues for the management of trauma cases in thoracic surgery emergency departments. Careful evaluation of patients with high-risk trauma mechanisms such as falls and traffic accidents is critical for preventing probable complications and determining appropriate treatment strategies (\u003csup\u003e14\u003c/sup\u003e). Understanding the impact of factors such as trauma mechanism and age on injury extent allows for more targeted and effective interventions in trauma management.\u003c/p\u003e\n\u003ch1\u003eLimitation\u003c/h1\u003e\n\u003cp\u003eOur study consisted of a patient population from a regional secondary care hospital in a city with lower criminal incidents and higher farmer and gardener population ratio than the rest of the country. Therefore the percentage of penetrating injury cases was significantly low, while falls from heights, such as fruit trees, might be found as more common. This affects the prevalence of trauma etiologies. However, the endpoint of this study was independent of this factor, as we focused on evaluating specific risk factors and their association with trauma outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the mechanism of trauma and age have a significant effect on the extent of injury in chest trauma. While falls and road traffic accidents increase the risk of rib fractures, the older age group is at higher risk for hemothorax and rib fractures. Increased trauma score was associated with concomitant trauma and the need for intensive care. These findings highlight important points to consider in the evaluation of trauma patients. \u0026nbsp; Factors such as trauma type and age should be taken into account in the management of trauma patients in order to provide patients with the right treatment options and to prevent complications. A detailed and meticulous approach should be adopted in the acute management of thoracic traumas.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eİ.S. and İ.S. designed the study. İ.S. N.S.E. collected data. N.S.E. and K.\u0026Ouml;. reviewed literature. İ.S. made the analysis. İ.S. and K.\u0026Ouml;. wrote the main manuscript. İ.S. prepared figures, made critical review and supervised the study. All authors reviewed the manuscript.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e None to declare\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBattle C, Cole E, Whelan R, et al. Scoping review of the literature to ascertain how the STUMBL Score clinical prediction model is used to manage patients with blunt chest wall trauma in emergency care. \u003cem\u003eInjury\u003c/em\u003e. 2023;54:110796.\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;ınar E, İnan K, Yıldız \u0026Ouml;\u0026Ouml;. Clinical analysis with trauma scoring in blunt thoracic trauma. \u003cem\u003eKafkas J Med Sci\u003c/em\u003e. 2021;11:208\u0026ndash;213.\u003c/li\u003e\n\u003cli\u003eMartin TJ, Eltorai AS, Dunn R, et al. Clinical management of rib fractures and methods for prevention of pulmonary complications: A review. \u003cem\u003eInjury\u003c/em\u003e. 2019;50:1159\u0026ndash;1165.\u003c/li\u003e\n\u003cli\u003eBouzat P, Raux M, David JS, et al. Chest trauma: First 48hours management. \u003cem\u003eAnaesth Crit Care Pain Med\u003c/em\u003e. 2017;36:135\u0026ndash;145.\u003c/li\u003e\n\u003cli\u003eBenhamed A, Ndiaye A, Emond M, et al. Road traffic accident-related thoracic trauma: Epidemiology, injury pattern, outcome, and impact on mortality-A multicenter observational study. \u003cem\u003ePLoS One\u003c/em\u003e. 2022;17:e0268202.\u003c/li\u003e\n\u003cli\u003eParreira JG, Matar MR, T\u0026ocirc;rres ALB, et al. Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma. \u003cem\u003eRev Col Bras Cir\u003c/em\u003e. 2014;41:272\u0026ndash;277.\u003c/li\u003e\n\u003cli\u003ePasquali GF, Kock K de S. Epidemiological profile of chest trauma and predictive factors for length of hospital stay in a hospital in Southern Brazil. \u003cem\u003eInt J Burns Trauma\u003c/em\u003e. 2021;11:54\u0026ndash;61.\u003c/li\u003e\n\u003cli\u003eKapicibasi HO. Age differences in blunt chest trauma: a cross-sectional study. \u003cem\u003eKardiochir Torakochirurgia Pol\u003c/em\u003e. 2020;17:123\u0026ndash;126.\u003c/li\u003e\n\u003cli\u003eDeng H, Tang T-X, Yao Y, et al. The incidence, clinical characteristics, and outcome of polytrauma patients with the combination of pulmonary contusion, flail chest and upper thoracic spinal injury. \u003cem\u003eInjury\u003c/em\u003e. 2022;53:1073\u0026ndash;1080.\u003c/li\u003e\n\u003cli\u003eKlempka A, Fischer C, Kauczor H-U, et al. Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Polytrauma Injury. \u003cem\u003eRofo\u003c/em\u003e. 2021;193:177\u0026ndash;185.\u003c/li\u003e\n\u003cli\u003eKavurmacı \u0026Ouml;, Ak\u0026ccedil;ay O. Toraks Travmalarında İleri Yaş Neleri Değiştirmektedir? \u003cem\u003eSak Med J\u003c/em\u003e. . Epub ahead of print March 16, 2020. DOI: 10.31832/smj.627502.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Donovan S, van den Heuvel C, Baldock M, et al. Fatal blunt chest trauma: an evaluation of rib fracture patterns and age. \u003cem\u003eInt J Legal Med\u003c/em\u003e. 2022;136:1351\u0026ndash;1357.\u003c/li\u003e\n\u003cli\u003eBirse F, Williams H, Shipway D, et al. Blunt chest trauma in the elderly: an expert practice review. \u003cem\u003eEmerg Med J\u003c/em\u003e. 2020;37:73\u0026ndash;78.\u003c/li\u003e\n\u003cli\u003eBattle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. \u003cem\u003eInjury\u003c/em\u003e. 2012;43:8\u0026ndash;17.\u003c/li\u003e\n\u003cli\u003eTisherman SA, Stein DM. ICU Management of Trauma Patients. \u003cem\u003eCrit Care Med\u003c/em\u003e. 2018;46:1991\u0026ndash;1997.\u003c/li\u003e\n\u003cli\u003ePape H-C, Halvachizadeh S, Leenen L, et al. Timing of major fracture care in polytrauma patients - An update on principles, parameters and strategies for 2020. \u003cem\u003eInjury\u003c/em\u003e. 2019;50:1656\u0026ndash;1670.\u003c/li\u003e\n\u003cli\u003eCrawford AM, Yang S, Hu P, et al. Concomitant chest trauma and traumatic brain injury, biomarkers correlate with worse outcomes. \u003cem\u003eJ Trauma Acute Care Surg\u003c/em\u003e. 2019;87:S146\u0026ndash;S151.\u003c/li\u003e\n\u003cli\u003eBlondonnet R, Begard M, Jabaudon M, et al. Blunt Chest Trauma and Regional Anesthesia for Analgesia of Multitrauma Patients in French Intensive Care Units: A National Survey. \u003cem\u003eAnesth Analg\u003c/em\u003e. 2021;133:723\u0026ndash;730.\u003c/li\u003e\n\u003cli\u003ePressley CM, Fry WR, Philp AS, et al. Predicting outcome of patients with chest wall injury. \u003cem\u003eAm J Surg\u003c/em\u003e. 2012;204:910\u0026ndash;3; discussion 913\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eChen J, Jeremitsky E, Philp F, et al. A chest trauma scoring system to predict outcomes. \u003cem\u003eSurgery\u003c/em\u003e. 2014;156:988\u0026ndash;993.\u003c/li\u003e\n\u003cli\u003eAdrese Dayalı N\u0026uuml;fus Kayıt Sistemi Sonu\u0026ccedil;ları, T\u0026uuml;rkiye İstatistik Kurumu, 2023. [Internet]. 2024 [Access date: July 11th 2024]. Access address: https://data.tuik.gov.tr/Bulten/Index?p=Adrese-Dayali-Nufus-Kayit-Sistemi-Sonuclari-2023-49684\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eDistribution and percentage of demographics, trauma types and management\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"393\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 68.7023%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 68.7023%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e69.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eFemal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 68.7023%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 68.7023%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eCity center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e45.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eRural areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e55.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 68.7023%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrauma type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e58.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eCar accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eBlunt force trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eMotorcycle accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003ePenetrating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eCrush\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003ePost-resuscitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 68.7023%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eConservative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e87.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eChest tube\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eThoracic surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 68.7023%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eManagement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eHospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eIntensive care unit admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eReferred to another facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.6514%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60.0509%;\"\u003e\n \u003cp\u003eReferred to outpatient clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5394%;\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7583%;\"\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eMultinomial logistic regression analysis of factors increasing the risk of rib fractures in patients who fall\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3128%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eB\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20.1331%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStandard Error\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.807%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOdds Ratio\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.6206%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e95% Confidence Interval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.975%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep Value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3128%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20.1331%;\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.807%;\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.6206%;\"\u003e\n \u003cp\u003e0.963 - 2.967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.975%;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3128%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20.1331%;\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.807%;\"\u003e\n \u003cp\u003e2.476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.6206%;\"\u003e\n \u003cp\u003e1.398 - 4.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.975%;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3128%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.15141%;\"\u003e\n \u003cp\u003e1.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20.1331%;\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.807%;\"\u003e\n \u003cp\u003e4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.6206%;\"\u003e\n \u003cp\u003e2.42 - 7.781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.975%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eChest trauma scoring (CTS) system\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"503\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003eAge \u0026lt;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003e\u0026lt;3 Rib fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003eAge 45-65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003e3-5 Rib fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003eAge \u0026gt;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003e\u0026gt;5 Rib fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePulmonary contusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral rib fracture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003eUnilateral minor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003eUnilateral major\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003eBilateral minor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.7972%;\"\u003e\n \u003cp\u003eBilateral major\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15.1093%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 3.57853%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.2008%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.3141%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"chest trauma, rib fractures, trauma mechanisms, age-related injury, trauma outcomes","lastPublishedDoi":"10.21203/rs.3.rs-5334682/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5334682/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study evaluated the effects of trauma mechanisms and age intervals on injury extent and prognosis in chest traumas to enhance trauma management strategies.\u003c/p\u003e\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChest traumas are a major cause of morbidity and mortality globally, often resulting from high-energy impacts like motor vehicle accidents, falls, crushing injuries, and penetrating injuries. These can lead to various injuries, including lung contusions and rib fractures, requiring urgent medical or surgical intervention. The injury severity and mechanism, along with factors such as age and gender, influence clinical outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a retrospective study of 525 patients with thoracic trauma presenting to a secondary-care public hospital from May 2022 to May 2024. Demographic profiles, diagnoses, radiological findings, and surgical procedures were recorded and analyzed using Binary and Multinomial Logistic Regression and Chi-square tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 525 patients, 158 were female, and 367 were male. The most common trauma etiologies were falls (58.7%) and traffic accidents (22.7%). Rib fractures were the most frequent injury (67.2%), with older patients and females at higher risk. Concomitant injuries were present in 28% of cases, mainly in traffic accidents. Intensive care was required in 12.4% of cases, especially after post-resuscitation, crush traumas, and polytrauma. The Chest Trauma Score (CTS) correlated with the hospitalization, requirement for intensive care, hemothorax, pneumothorax, and concomitant injuries.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe mechanism of injury and age significantly impact injury extent in chest traumas. Falls and traffic accidents increase the risk of rib fractures, while older patients are at higher risk for hemothorax and rib fractures. An increased trauma score is related to concomitant injuries and the requirement for intensive care. These findings emphasize the importance of factoring in both the type of trauma and the age in patient management to provide appropriate treatment and prevent complications.\u003c/p\u003e","manuscriptTitle":" Assessing the Impact of Trauma Score, Mechanisms and Demographics on Chest Injury Outcomes ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-20 11:19:56","doi":"10.21203/rs.3.rs-5334682/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c46bbc8-2c0b-4ee6-bded-9ef673897be4","owner":[],"postedDate":"November 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-04T12:23:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-20 11:19:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5334682","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5334682","identity":"rs-5334682","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}