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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">We undertook a review of patients with chest trauma attended between January 1992 and June 2005 in order to establish severity criteria in these cases&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">During the study period&#44; 1772 cases &#40;1346 &#91;76&#37;&#93; males&#41; were treated&#44; with ages ranging from 7 to 98 years &#40;mean&#44; 46&#46;4 years&#41;&#46; The Revised Trauma Score &#40;RTS&#41; was calculated and the following variables were also studied as potential indicators of severity&#58; age&#44; extent of the injury&#44; number of rib fractures&#44; presence of lung contusion&#44; hemothorax&#44; cardiorespiratory repercussions&#44; and need for mechanical ventilation&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">At the time of admission&#44; 84&#46;4&#37; of patients presented only symptoms related to the injury&#44; with no general repercussions&#44; and 66&#46;7&#37; had an RTS of 12&#46; The number of rib fractures was a reliable indicator of severity&#44; as was the presence of multiple injuries&#44; lung contusion&#44; need for mechanical ventilation&#44; and cardiorespiratory repercussions&#46; Neither age nor presence of hemothorax was found to be an indicator of severity&#46; Pleural drainage was performed in 756 cases and was effective in 670 &#40;88&#46;6&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">There are a number of indicators of severity in chest trauma&#44; related more closely to the type and repercussions of the trauma than to the age of the patient&#46; There is a high incidence of fluid or gas accumulation in the pleural space&#44; though this can be easily managed by pleural drainage&#44; which constitutes the main therapeutic procedure in chest trauma&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Revisamos la experiencia en traumatismos to-r&#225;cicos &#40;TT&#41; atendidos entre enero de 1992 y junio de 2005 con la intenci&#243;n de establecer criterios de gravedad en ellos&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Durante dicho per&#237;odo se atendieron 1&#46;772 casos con edades comprendidas entre los 7 y 98 a&#241;os &#40;1&#46;346 varones&#59; 76&#37;&#41; y con una media de edad de 46&#44;4 a&#241;os&#46; Se aplic&#243; la escala Revised Trauma Score &#40;RTS&#41; y se tuvieron en cuenta&#44; como indicadores&#44; la edad&#44; el grado de traumatismo&#44; el n&#250;mero de fracturas costales&#44; la presencia de contusi&#243;n pulmonar&#44; hemot&#243;rax&#44; la repercusi&#243;n cardiorrespiratoria y la necesidad de ventilaci&#243;n mec&#225;nica&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">En el momento del ingreso el 84&#44;4&#37; ten&#237;a &#250;nicamente s&#237;ntomas relacionados con el traumatismo&#44; sin repercusi&#243;n general&#44; y el 66&#44;7&#37; presentaba un &#237;ndice RTS de 12&#46; El n&#250;mero de fracturas costales fue un marcador eficaz de gravedad&#44; al igual que la presencia de politraumatismo&#44; contusi&#243;n pulmonar&#44; necesidad de ventilaci&#243;n mec&#225;nica y repercusi&#243;n cardiorrespiratoria&#46; La edad no se revel&#243; como un &#237;ndice de gravedad&#44; y tampoco la presencia de hemot&#243;rax&#46; En 756 ocasiones se realiz&#243; drenaje pleural&#44; que fue resolutivo en 670 &#40;88&#44;6&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los TT tienen una serie de indicadores de gravedad&#44; m&#225;s relacionados con el tipo e impacto del traumatismo que con la edad del paciente&#46; El s&#237;ndrome de ocupaci&#243;n pleural es un problema de mucha incidencia&#44; aunque de resoluci&#243;n f&#225;cil con un drenaje pleural&#46; &#201;ste constituye la principal arma terap&#233;utica en los TT&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Manejo inicial de los traumatismos tor&#225;cicos"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J Freixinet"
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                    0 => array:1 [
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                        "tituloSerie" => "Rev Patol Respir"
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                        "titulo" => "Comit&#233; de Trauma del Colegio Americano de Cirujanos&#46; Programa avanzado de apoyo vital en trauma para m&#233;dicos"
                        "fecha" => "1997"
                        "editorial" => "American College of Surgeons"
                        "editorialLocalizacion" => "Chicago"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A revision of the Trauma Score"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "HR Champion"
                            1 => "WJ Sacco"
                            2 => "WS Copes"
                            3 => "DS Gann"
                            4 => "TA Gennarelli"
                            5 => "ME Flanagan"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
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                        "tituloSerie" => "J Trauma"
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                        "paginaInicial" => "623"
                        "paginaFinal" => "629"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2657085"
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                      "titulo" => "Blunt chest trauma in the elderly"
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                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "RM Shorr"
                            1 => "R Rodr&#237;guez"
                            2 => "MC Indeck"
                            3 => "MD Crittenden"
                            4 => "S Hartunian"
                            5 => "A Cowley"
                          ]
                        ]
                      ]
                    ]
                  ]
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                          "autores" => array:5 [
                            0 => "J Freixinet"
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                            2 => "J Beltr&#225;n"
                            3 => "M Hussein"
                            4 => "MJ Roca"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Mapfre Medicina"
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                        "paginaFinal" => "5"
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                      "titulo" => "Heridas tor&#225;cicas&#46; Experiencia en 126 casos"
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                          "autores" => array:6 [
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                            1 => "M Pera"
                            2 => "AM Lacy"
                            3 => "JM Gimferrer"
                            4 => "M Catal&#225;n"
                            5 => "M Mateu"
                          ]
                        ]
                      ]
                    ]
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                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Quir Esp"
                        "fecha" => "1987"
                        "volumen" => "14"
                        "paginaInicial" => "63"
                        "paginaFinal" => "68"
                      ]
                    ]
                  ]
                ]
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                      "titulo" => "Heridas tor&#225;cicas por arma blanca"
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                          "autores" => array:5 [
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                            1 => "C Val-Carreres"
                            2 => "A Escart&#237;n"
                            3 => "JL Blas"
                            4 => "M Gonz&#225;lez"
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                        ]
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                        "paginaInicial" => "329"
                        "paginaFinal" => "332"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9762393"
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                          "autores" => array:4 [
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                            1 => "A S&#225;nchez-Palencia"
                            2 => "A Cueto"
                            3 => "JM D&#237;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1999"
                        "volumen" => "35"
                        "paginaInicial" => "84"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10410232"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatismos tor&#225;cicos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A Varela"
                            1 => "P G&#225;mez"
                            2 => "L Madrigal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2000"
                        "volumen" => "36"
                        "numero" => "Supl 1"
                        "paginaInicial" => "15"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10786269"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Penetrating chest wounds&#58; 24 years experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "AK Mandal"
                            1 => "M Sanusi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "2001"
                        "volumen" => "25"
                        "paginaInicial" => "1145"
                        "paginaFinal" => "1149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11571950"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decelerational thoracic injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "KG Swan Jr"
                            1 => "BC Swan"
                            2 => "KG Swan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2001"
                        "volumen" => "51"
                        "paginaInicial" => "970"
                        "paginaFinal" => "974"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11706348"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors predicting early in-hospital death in blunt thoracic aortic injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "BJ Simon"
                            1 => "C Leslie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2001"
                        "volumen" => "51"
                        "paginaInicial" => "906"
                        "paginaFinal" => "911"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11706338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute and long-term clinical significance of myocardial contusion following blunt thoracic trauma&#58; results of a prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M Lindstaedt"
                            1 => "A Germing"
                            2 => "T Lawo"
                            3 => "S Von Dryander"
                            4 => "D Jaeger"
                            5 => "G Muhr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2002"
                        "volumen" => "52"
                        "paginaInicial" => "479"
                        "paginaFinal" => "485"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11901323"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatismos tor&#225;cicos en una unidad especializada&#46; Epidemiolog&#237;a y morbimortalidad"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J Casanova"
                            1 => "C Mor&#225;n"
                            2 => "J Pac"
                            3 => "J Mari&#241;&#225;n"
                            4 => "JM Izquierdo"
                            5 => "R Rojo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1994"
                        "volumen" => "30"
                        "paginaInicial" => "248"
                        "paginaFinal" => "250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8025800"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatismos laringotraqueobronquiales"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J Freixinet"
                            1 => "P Rodr&#237;guez"
                            2 => "N Santana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2000"
                        "volumen" => "36"
                        "numero" => "Supl 1"
                        "paginaInicial" => "57"
                        "paginaFinal" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10786276"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rupture of the airways from blunt trauma&#58; treatment of complex injuries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P Symbas"
                            1 => "AG Justicz"
                            2 => "RR Ricketts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1992"
                        "volumen" => "54"
                        "paginaInicial" => "177"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1610239"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatic injuries of the diaphragm&#46; Experience in 33 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J Freixinet"
                            1 => "JM Segur"
                            2 => "C Mestres"
                            3 => "M Mateu"
                            4 => "JM Gimferrer"
                            5 => "M Catal&#225;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2007-1020233"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorac Cardiovasc Surg"
                        "fecha" => "1987"
                        "volumen" => "35"
                        "paginaInicial" => "215"
                        "paginaFinal" => "218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2444003"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lesiones diafragm&#225;ticas&#44; cardiovasculares y traqueobronquiales en los traumatismos tor&#225;cicos cerrados"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A Esteban"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cir Esp"
                        "fecha" => "2000"
                        "volumen" => "67"
                        "paginaInicial" => "469"
                        "paginaFinal" => "476"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; severity and patterns of intrathoracic and intraabdominal injuries in motorcycle crashes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "JF Kraus"
                            1 => "C Peek-Asa"
                            2 => "G Cryer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2002"
                        "volumen" => "52"
                        "paginaInicial" => "548"
                        "paginaFinal" => "553"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11901334"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic factors in blunt chest trauma&#46; Analysis of 652 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "JL Svennevig"
                            1 => "B Bugge-Asperheim"
                            2 => "OR Geiran"
                            3 => "J Vaage"
                            4 => "J Pillgram-Larsen"
                            5 => "NB Fjeld"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Chir Gynaecol"
                        "fecha" => "1986"
                        "volumen" => "75"
                        "paginaInicial" => "8"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3707028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Presence of three or more rib fractures as an indicator of need for interhospital transfer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "RB Lee"
                            1 => "JA Morris"
                            2 => "RS Parker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1989"
                        "volumen" => "29"
                        "paginaInicial" => "780"
                        "paginaFinal" => "795"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rib fractures in children&#58; a marker of severe trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "VF Garc&#237;a"
                            1 => "CS Gotschall"
                            2 => "MR Eichelberger"
                            3 => "LM Bowman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1990"
                        "volumen" => "30"
                        "paginaInicial" => "695"
                        "paginaFinal" => "700"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2352299"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Three or more rib fractures as an indicator for transfer to a level I trauma center&#58; a population-based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "RB Lee"
                            1 => "SM Bass"
                            2 => "JA Morris"
                            3 => "EJ MacKenzie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1990"
                        "volumen" => "30"
                        "paginaInicial" => "689"
                        "paginaFinal" => "694"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2352298"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comprehensive analysis of traumatic rib fractures&#58; morbidity&#44; mortality and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M Sirmali"
                            1 => "H Turut"
                            2 => "S Topcu"
                            3 => "E Gulham"
                            4 => "U Yazici"
                            5 => "S Kaya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "133"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12853057"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Morbidity from rib fractures increases after age 45"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "JB Holcomb"
                            1 => "NR McMullin"
                            2 => "RA Kozar"
                            3 => "MH Lygas"
                            4 => "FA Moore"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1072-7515(02)01894-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Surg"
                        "fecha" => "2003"
                        "volumen" => "196"
                        "paginaInicial" => "549"
                        "paginaFinal" => "555"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12691929"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Half-a-dozen ribs&#58; the breakpoint for mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "BT Flagel"
                            1 => "FA Luchette"
                            2 => "RL Reed"
                            3 => "TJ Esposito"
                            4 => "KA Davis"
                            5 => "JM Santaniello"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.surg.2005.07.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surgery"
                        "fecha" => "2005"
                        "volumen" => "138"
                        "paginaInicial" => "717"
                        "paginaFinal" => "723"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16269301"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adverse outcomes in younger rib fracture patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "GM Testerman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.smj.0000203815.29757.d3"
                      "Revista" => array:6 [
                        "tituloSerie" => "South Med J"
                        "fecha" => "2006"
                        "volumen" => "99"
                        "paginaInicial" => "335"
                        "paginaFinal" => "339"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16634240"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Strut fixation of an extensive flail chest"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R Landreneau"
                            1 => "J Hinson"
                            2 => "SR Hazelrigg"
                            3 => "JA Johnson"
                            4 => "TM Boley"
                            5 => "JJ Curtis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1991"
                        "volumen" => "51"
                        "paginaInicial" => "473"
                        "paginaFinal" => "475"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1998429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of flail chest on outcome among patients with severe thoracic cage trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "GC Velmahos"
                            1 => "P Vassiliu"
                            2 => "LS Chan"
                            3 => "JA Murray"
                            4 => "TV Berne"
                            5 => "D Demetriades"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Surg"
                        "fecha" => "2002"
                        "volumen" => "87"
                        "paginaInicial" => "240"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12575808"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Marcadores pron&#243;sticos en los pacientes con traumatismo tor&#225;cico cerrado"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B Virg&#243;s"
                            1 => "AC Nebra"
                            2 => "C S&#225;nchez"
                            3 => "A Broto"
                            4 => "MA Su&#225;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "489"
                        "paginaFinal" => "494"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15530340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Considerations in the management of acute traumatic hemothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "AC Beall"
                            1 => "HW Crawford"
                            2 => "ME de Bakey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1966"
                        "volumen" => "52"
                        "paginaInicial" => "351"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5919388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "TS Helling"
                            1 => "NR Gyles"
                            2 => "CL Eisenstein"
                            3 => "CA Soracco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1989"
                        "volumen" => "29"
                        "paginaInicial" => "1367"
                        "paginaFinal" => "1370"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2810412"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A population-based study on pneumothorax in severely traumatized patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S Di Bartolomeo"
                            1 => "G Sanson"
                            2 => "G Nardi"
                            3 => "F Scian"
                            4 => "V Michelutto"
                            5 => "L Lattuada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2001"
                        "volumen" => "51"
                        "paginaInicial" => "677"
                        "paginaFinal" => "682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11586158"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chest injuries in civilian life and their treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G &#214;zgen"
                            1 => "I Duygulu"
                            2 => "H Solak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1984"
                        "volumen" => "85"
                        "paginaInicial" => "89"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6690257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blunt chest injuries in 1969 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G Gal&#225;n"
                            1 => "JC Pe&#241;alver"
                            2 => "F Par&#237;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Cardiothoracic Surg"
                        "fecha" => "1992"
                        "volumen" => "31"
                        "paginaInicial" => "971"
                        "paginaFinal" => "973"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rib fracture stabilization in patients sustaining blunt chest injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R Nirula"
                            1 => "B Allen"
                            2 => "R Layman"
                            3 => "ME Falimirski"
                            4 => "LB Somberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Surg"
                        "fecha" => "2006"
                        "volumen" => "72"
                        "paginaInicial" => "307"
                        "paginaFinal" => "309"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16676852"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nosocomial respiratory tract infections in multiple trauma patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J Rello"
                            1 => "V Ausina"
                            2 => "J Castella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1992"
                        "volumen" => "102"
                        "paginaInicial" => "525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1643942"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blunt chest trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "VO Adegboye"
                            1 => "JK Ladipo"
                            2 => "IA Brimmo"
                            3 => "AO Adebo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Afr J Med Sci"
                        "fecha" => "2002"
                        "volumen" => "31"
                        "paginaInicial" => "315"
                        "paginaFinal" => "320"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary disability after severe blunt chest trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "DH Livingstone"
                            1 => "JD Richardson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1990"
                        "volumen" => "30"
                        "paginaInicial" => "562"
                        "paginaFinal" => "567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2342139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality prognostic factors in chest injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M Gaillard"
                            1 => "C Herve"
                            2 => "L Mandin"
                            3 => "P Raynaud"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1990"
                        "volumen" => "30"
                        "paginaInicial" => "93"
                        "paginaFinal" => "96"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2296073"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of pulmonary complications in blunt chest trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J Satiego"
                            1 => "JL Brown"
                            2 => "T Matsumoto"
                            3 => "MD Kerstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Surg"
                        "fecha" => "1993"
                        "volumen" => "78"
                        "paginaInicial" => "320"
                        "paginaFinal" => "323"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8175260"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Vol. 44. Issue 5.
Pages 257-262 (January 2008)
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Vol. 44. Issue 5.
Pages 257-262 (January 2008)
Original Articles
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Indicators of Severity in Chest Trauma
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Jordi Freixineta,*, Juan Beltrána, Pedro Miguel Rodrígueza, Gabriel Juliáb, Mohammed Husseina, Rita Gila, Jorge Herreroa
a Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
b Servicio de Neumología, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
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Objective

We undertook a review of patients with chest trauma attended between January 1992 and June 2005 in order to establish severity criteria in these cases.

Patients and methods

During the study period, 1772 cases (1346 [76%] males) were treated, with ages ranging from 7 to 98 years (mean, 46.4 years). The Revised Trauma Score (RTS) was calculated and the following variables were also studied as potential indicators of severity: age, extent of the injury, number of rib fractures, presence of lung contusion, hemothorax, cardiorespiratory repercussions, and need for mechanical ventilation.

Results

At the time of admission, 84.4% of patients presented only symptoms related to the injury, with no general repercussions, and 66.7% had an RTS of 12. The number of rib fractures was a reliable indicator of severity, as was the presence of multiple injuries, lung contusion, need for mechanical ventilation, and cardiorespiratory repercussions. Neither age nor presence of hemothorax was found to be an indicator of severity. Pleural drainage was performed in 756 cases and was effective in 670 (88.6%).

Conclusions

There are a number of indicators of severity in chest trauma, related more closely to the type and repercussions of the trauma than to the age of the patient. There is a high incidence of fluid or gas accumulation in the pleural space, though this can be easily managed by pleural drainage, which constitutes the main therapeutic procedure in chest trauma.

Key words:
Chest trauma
Rib fractures
Hemothorax
Traumatic pneumothorax
Objetivo

Revisamos la experiencia en traumatismos to-rácicos (TT) atendidos entre enero de 1992 y junio de 2005 con la intención de establecer criterios de gravedad en ellos.

Pacientes y métodos

Durante dicho período se atendieron 1.772 casos con edades comprendidas entre los 7 y 98 años (1.346 varones; 76%) y con una media de edad de 46,4 años. Se aplicó la escala Revised Trauma Score (RTS) y se tuvieron en cuenta, como indicadores, la edad, el grado de traumatismo, el número de fracturas costales, la presencia de contusión pulmonar, hemotórax, la repercusión cardiorrespiratoria y la necesidad de ventilación mecánica.

Resultados

En el momento del ingreso el 84,4% tenía únicamente síntomas relacionados con el traumatismo, sin repercusión general, y el 66,7% presentaba un índice RTS de 12. El número de fracturas costales fue un marcador eficaz de gravedad, al igual que la presencia de politraumatismo, contusión pulmonar, necesidad de ventilación mecánica y repercusión cardiorrespiratoria. La edad no se reveló como un índice de gravedad, y tampoco la presencia de hemotórax. En 756 ocasiones se realizó drenaje pleural, que fue resolutivo en 670 (88,6%).

Conclusiones

Los TT tienen una serie de indicadores de gravedad, más relacionados con el tipo e impacto del traumatismo que con la edad del paciente. El síndrome de ocupación pleural es un problema de mucha incidencia, aunque de resolución fácil con un drenaje pleural. Éste constituye la principal arma terapéutica en los TT.

Palabras clave:
Traumatismos torácicos
Fracturas costales
Hemotórax
Neumotórax traumático
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References
[1]
J Freixinet.
Manejo inicial de los traumatismos torácicos.
Rev Patol Respir, 4 (2001), pp. 77-78
[2]
ATLS.
Comité de Trauma del Colegio Americano de Cirujanos. Programa avanzado de apoyo vital en trauma para médicos, American College of Surgeons, (1997),
[3]
HR Champion, WJ Sacco, WS Copes, DS Gann, TA Gennarelli, ME Flanagan.
A revision of the Trauma Score.
J Trauma, 29 (1989), pp. 623-629
[4]
RM Shorr, R Rodríguez, MC Indeck, MD Crittenden, S Hartunian, A Cowley.
Blunt chest trauma in the elderly.
J Trauma, 29 (1989), pp. 234-237
[5]
J Freixinet, A Gyhra, J Beltrán, M Hussein, MJ Roca.
Traumatismos torácicos en el anciano.
Mapfre Medicina, 9 (1998), pp. 1-5
[6]
J Freixinet, M Pera, AM Lacy, JM Gimferrer, M Catalán, M Mateu, et al.
Heridas torácicas. Experiencia en 126 casos.
Rev Quir Esp, 14 (1987), pp. 63-68
[7]
A Val-Carreres, C Val-Carreres, A Escartín, JL Blas, M González.
Heridas torácicas por arma blanca.
Arch Bronconeumol, 34 (1998), pp. 329-332
[8]
J Ruiz, A Sánchez-Palencia, A Cueto, JM Díez.
Heridas torácicas: revisión de 90 casos.
Arch Bronconeumol, 35 (1999), pp. 84-90
[9]
A Varela, P Gámez, L Madrigal.
Traumatismos torácicos.
Arch Bronconeumol, 36 (2000), pp. 15-20
[10]
AK Mandal, M Sanusi.
Penetrating chest wounds: 24 years experience.
World J Surg, 25 (2001), pp. 1145-1149
[11]
KG Swan Jr, BC Swan, KG Swan.
Decelerational thoracic injury.
J Trauma, 51 (2001), pp. 970-974
[12]
BJ Simon, C Leslie.
Factors predicting early in-hospital death in blunt thoracic aortic injury.
J Trauma, 51 (2001), pp. 906-911
[13]
M Lindstaedt, A Germing, T Lawo, S Von Dryander, D Jaeger, G Muhr, et al.
Acute and long-term clinical significance of myocardial contusion following blunt thoracic trauma: results of a prospective study.
J Trauma, 52 (2002), pp. 479-485
[14]
J Casanova, C Morán, J Pac, J Mariñán, JM Izquierdo, R Rojo, et al.
Traumatismos torácicos en una unidad especializada. Epidemiología y morbimortalidad.
Arch Bronconeumol, 30 (1994), pp. 248-250
[15]
J Freixinet, P Rodríguez, N Santana.
Traumatismos laringotraqueobronquiales.
Arch Bronconeumol, 36 (2000), pp. 57-60
[16]
P Symbas, AG Justicz, RR Ricketts.
Rupture of the airways from blunt trauma: treatment of complex injuries.
Ann Thorac Surg, 54 (1992), pp. 177-183
[17]
J Freixinet, JM Segur, C Mestres, M Mateu, JM Gimferrer, M Catalán, et al.
Traumatic injuries of the diaphragm. Experience in 33 cases.
Thorac Cardiovasc Surg, 35 (1987), pp. 215-218
[18]
A Esteban.
Lesiones diafragmáticas, cardiovasculares y traqueobronquiales en los traumatismos torácicos cerrados.
Cir Esp, 67 (2000), pp. 469-476
[19]
JF Kraus, C Peek-Asa, G Cryer.
Incidence, severity and patterns of intrathoracic and intraabdominal injuries in motorcycle crashes.
J Trauma, 52 (2002), pp. 548-553
[20]
JL Svennevig, B Bugge-Asperheim, OR Geiran, J Vaage, J Pillgram-Larsen, NB Fjeld, et al.
Prognostic factors in blunt chest trauma. Analysis of 652 cases.
Ann Chir Gynaecol, 75 (1986), pp. 8-14
[21]
RB Lee, JA Morris, RS Parker.
Presence of three or more rib fractures as an indicator of need for interhospital transfer.
J Trauma, 29 (1989), pp. 780-795
[22]
VF García, CS Gotschall, MR Eichelberger, LM Bowman.
Rib fractures in children: a marker of severe trauma.
J Trauma, 30 (1990), pp. 695-700
[23]
RB Lee, SM Bass, JA Morris, EJ MacKenzie.
Three or more rib fractures as an indicator for transfer to a level I trauma center: a population-based study.
J Trauma, 30 (1990), pp. 689-694
[24]
M Sirmali, H Turut, S Topcu, E Gulham, U Yazici, S Kaya, et al.
A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management.
Eur J Cardiothorac Surg, 24 (2003), pp. 133-138
[25]
JB Holcomb, NR McMullin, RA Kozar, MH Lygas, FA Moore.
Morbidity from rib fractures increases after age 45.
J Am Coll Surg, 196 (2003), pp. 549-555
[26]
BT Flagel, FA Luchette, RL Reed, TJ Esposito, KA Davis, JM Santaniello, et al.
Half-a-dozen ribs: the breakpoint for mortality.
Surgery, 138 (2005), pp. 717-723
[27]
GM Testerman.
Adverse outcomes in younger rib fracture patients.
[28]
R Landreneau, J Hinson, SR Hazelrigg, JA Johnson, TM Boley, JJ Curtis.
Strut fixation of an extensive flail chest.
Ann Thorac Surg, 51 (1991), pp. 473-475
[29]
GC Velmahos, P Vassiliu, LS Chan, JA Murray, TV Berne, D Demetriades.
Influence of flail chest on outcome among patients with severe thoracic cage trauma.
Int Surg, 87 (2002), pp. 240-244
[30]
B Virgós, AC Nebra, C Sánchez, A Broto, MA Suárez.
Marcadores pronósticos en los pacientes con traumatismo torácico cerrado.
Arch Bronconeumol, 40 (2004), pp. 489-494
[31]
AC Beall, HW Crawford, ME de Bakey.
Considerations in the management of acute traumatic hemothorax.
J Thorac Cardiovasc Surg, 52 (1966), pp. 351-360
[32]
TS Helling, NR Gyles, CL Eisenstein, CA Soracco.
Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy.
J Trauma, 29 (1989), pp. 1367-1370
[33]
S Di Bartolomeo, G Sanson, G Nardi, F Scian, V Michelutto, L Lattuada.
A population-based study on pneumothorax in severely traumatized patients.
J Trauma, 51 (2001), pp. 677-682
[34]
G Özgen, I Duygulu, H Solak.
Chest injuries in civilian life and their treatment.
Chest, 85 (1984), pp. 89-92
[35]
G Galán, JC Peñalver, F París.
Blunt chest injuries in 1969 patients.
Eur J Cardiothoracic Surg, 31 (1992), pp. 971-973
[36]
R Nirula, B Allen, R Layman, ME Falimirski, LB Somberg.
Rib fracture stabilization in patients sustaining blunt chest injury.
Am Surg, 72 (2006), pp. 307-309
[37]
J Rello, V Ausina, J Castella.
Nosocomial respiratory tract infections in multiple trauma patients.
Chest, 102 (1992), pp. 525
[38]
VO Adegboye, JK Ladipo, IA Brimmo, AO Adebo.
Blunt chest trauma.
Afr J Med Sci, 31 (2002), pp. 315-320
[39]
DH Livingstone, JD Richardson.
Pulmonary disability after severe blunt chest trauma.
J Trauma, 30 (1990), pp. 562-567
[40]
M Gaillard, C Herve, L Mandin, P Raynaud.
Mortality prognostic factors in chest injury.
J Trauma, 30 (1990), pp. 93-96
[41]
J Satiego, JL Brown, T Matsumoto, MD Kerstein.
Predictors of pulmonary complications in blunt chest trauma.
Int Surg, 78 (1993), pp. 320-323
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