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Because of the controversy about the treatment of injured patients with steroids, each doctor treating closed chest injuries at Ullevål Hospital, Oslo, has been free to decide whether to use steroids. However, if steroids were to be used, early administration was recommended. Thus, on admission methylprednisolone 30mg/kg body weight was given to 107 patients having at least four rib fractures or a flail chest. The dose was repeated after 8 and 16 hours. The patients treated with steroids were compared with 159 patients not receiving steroids, but who otherwise were treated identically.
Three-quarters of the patients had multiple injuries and 219 patients (82 per cent) had intrathoracic injuries such as pneumothorax (39 per cent), haemothorax (37 per cent) or contusion of the lung (59 per cent). Forty-six patients (17 per cent) were in shock on admission.
Most patients could be managed with intravenous infusion, oxygen, relief of pain and chest drains. Early thoracotomy was performed in 10 patients and 91 patients needed artificial ventilation.
Analysis of the two groups of patients revealed a significantly lower hospital mortality of 11.2 per cent for those treated with steroids as against 23.3 per cent for those without. Comparison of the two groups demonstrated no differences which could explain the difference in mortality. The mean Injury Severity Score (ISS) was 24.0 for the steroid treated group and 21.4 for the control group. The steroid treatment was not associated with any increase in the incidence of infection. The present analysis indicates that steroids, when given early, may improve the clinical course of patients sustaining severe closed injuries of the chest. Our guidelines for the treatment of patients with chest injuries have been changed accordingly.
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Accepted: December 16, 1986
© 1987 Published by Elsevier Inc.