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The aim of the present study was to assess the prognostic significance of thoracic and abdominal trauma in severely injured patients. A retrospective analysis was performed based on data from the period from March 1 2006 to December 31 2007, taken from the Trauma Registry of the University Hospital "SantAndrea" in Rome. A total of 844 trauma patients were entered in a database created for this purpose, and only patients with an Injury Severity Score (ISS)15, (163 patients, 19.3%), were selected for the present study. These patients were divided into 2 groups: Group A (103 patients, 63.2%), consisting of patients with at least one thoracic injury, and Group B (46 patients, 28.2%) consisting of patients with concomitant thoracic and abdominal injuries. The impact of thoracic and abdominal trauma was studied by analyzing mortality and morbidity, in relation to patient age, cause and dynamics of trauma, length of hospital stay, and both ISS and New ISS (NISS). In a vast majority of cases, the cause of trauma was a road accident (126 patients, 77.3%). The mean age of patients with ISS15 was 45.2 +/- 19.3 years. The mean ISS and NISS were 25.7 +/- 10.5 and of 31.4 +/- 13.1 respectively. The overall morbidity and mortality rates were 18.4% (30 patients) and 28.8% (47 patients) respectively. In Group A the mortality rate was 23.3% (24 patients) and the morbidity rate was 33.9% (35 patients). In Group B mortality and morbidity rates were 369% (17 patients) and 43.5% (20 patients) respectively. It was shown that the presence of both thoracic and abdominal injuries significantly increases the risk of mortality and morbidity. In patients with predominantly thoracic injuries, NISS proved to be the more reliable score, while ISS appeared to be more accurate in evaluating patients with injuries affecting more than one region of the body.

Abdominal trauma is present in 7-10% of all trauma victims, and in cases of severe trauma is often found together with orthopedic, thoracic or central nervous system (CNS) injuries. The aim of the present study was to perform a comparative analysis of abdominal trauma and trauma involving other body regions, evaluating the prognostic significance of abdominal injuries in patients with severe trauma, based on data from a multidisciplinary trauma registry. Data from the period from March 1 2006 to December 31 2007 was collected from the trauma registry of the University Hospital Sant'Andrea in Rome, Italy. There were 25.875 patients (31.4%) with the diagnosis of trauma out of a total of 82.293 patients admitted to the emergency department. Eight hundred forty-four patients were selected according to specific inclusion criteria and patients with abdominal injuries were further selected. The following data were investigated: patient age, the trauma mechanism, duration of recovery, Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), type and the incidence of abdominal and extra-abdominal injuries. Morbidity and mortality, especially in patients with spleen and liver injuries, were analyzed. There were 79 patients (9.3%) with abdominal trauma. Their mean ISS was 25.7 +/- 14.3. Sixty-one (77.2%) of these patients had sustained severe trauma (ISS15). Forty-one patients (51.8%) underwent surgery. The overall mortality rate was 24.1%, 19 patients all with ISS15, so that the mortality rate for patients with severe trauma was 31.2%. Splenic trauma was the most frequent, and was found in 36 patients (45.6%) whose mean ISS was 31.1 +/- 144. Twenty-two patients (61.6%) were treated surgically; a total of 21 splenectomies and one laparoscopic procedure to control bleeding were performed. Overall mortality among patients with splenic trauma was 30.5% (11 patients), with an average spleen AIS of 3.3 +/- 0.8 (died vs. survived p = n.s.). Liver injuries were found in 33 patients (41.7%). The mean ISS was 28.4 +/- 11.6. Sixty-five percent of the patients were given nonsurgical treatment. Overall mortality among liver trauma patients was 24.2% (8 patients) with an average liver AIS of 3.2 +/- 0.3 (died vs. survived p0.05). In multivariate analysis, among the general population of trauma patients, the ISS (p0.001), patient age (p0.003), and an orthopedic (p0.002) or CNS injury (p0.006) proved to be significant independent predictors of the presence of an abdominal injury. Multivariate analysis showed that in patients with abdominal trauma, only the ISS (p0.001) was a significant independent predictor of mortality.