Advertisement
Research Article| Volume 18, ISSUE 5, P309-312, September 1987

Download started.

Ok

Early use of corticosteroids in severe closed chest injuries: a 10-year experience

DOI:https://doi.org/10.1016/0020-1383(87)90048-9
Early use of corticosteroids in severe closed chest injuries: a 10-year experience
Previous ArticleThe radiological deformity of Colles' fractures
Next ArticleUnemployment, alcohol and injury in West Belfast
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Alho A.
        Use of corticosteroids in the fat embolism syndrome.
        Int. Med. Spec. 1984; 5: 137
        • Alho A.
        • Saikku K.
        • Eerola P.
        • et al.
        Corticosteroids in patients with a high risk of fat embolism syndrome.
        Surg. Gynecol. Obstet. 1978; 147: 358
        • Franz J.L.
        • Richardson J.D.
        • Grover F.L.
        • et al.
        Effect of methylprednisolone sodium succinate on experimental pulmonary contusion.
        J. Thorac. Cardiovasc. Surg. 1974; 68: 842
        • Goris R.J.A.
        The injury severity score.
        World J. Surg. 1983; 7: 12
        • Johnson K.D.
        • Cadambi A.
        • Seibert G.B.
        Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures.
        J. Trauma. 1985; 25: 375
        • Lillehei R.C.
        • Longerbeam J.K.
        • Block J.H.
        • et al.
        The modern treatment of shock based on physiologic principles.
        Clin. Pharmacol. Ther. 1964; 5: 63
        • Lucas C.E.
        • Ledgerwood A.M.
        Pulmonary response of massive steroids in seriously injuried patients.
        Ann. Surg. 1981; 194: 256
        • Pepe P.E.
        • Potkin R.T.
        • Reus D.H.
        • et al.
        Clinical predictors of the adult respiratory distress syndrome.
        Am. J. Surg. 1982; 144: 124
        • Pinilla J.C.
        Acute respiratory failure in severe blunt chest trauma.
        J. Trauma. 1982; 22: 221
        • Replogle R.L.
        • Gazzaniga A.B.
        • Gross R.E.
        Use of corticosteroids during cardiopulmonary bypass: possible lysosome stabilization.
        Circulation. 1966; 33: 86
        • Rokkanen P.
        • Ahlo A.
        • Avikainen V.
        • et al.
        The efficacy of corticosteroids in severe trauma.
        Surg. Gynecol. Obstet. 1974; 138: 69
        • Schonfeld S.A.
        • Ploysongsang Y.
        • Dilisio R.
        • et al.
        Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients.
        Ann. Int. Med. 1983; 99: 438
        • Schumer W.
        Steroids in the treatment of clinical septic shock.
        Ann. Surg. 1976; 184: 333
        • Shier M.R.
        • Wilson R.F.
        • James R.E.
        • et al.
        Fat embolism prophylaxis: A study of four treatment modalities.
        J. Trauma. 1977; 17: 621
        • Sprung C.L.
        • Caralis P.V.
        • Marcial E.H.
        • et al.
        The effect of high-dose corticosteroids in patients with septic shock. A prospective, controlled study.
        N. Engl. J. Med. 1984; 311: 1137
        • Stoltenberg J.J.
        • Gustilo R.B.
        The use of methylprednisolone and hypertonic glucose in the prophylaxis of fat embolism syndrome.
        Clin. Orthop. 1979; 143: 211
        • Sutherland G.R.
        • Driedger A.A.
        • Holliday R.L.
        • et al.
        Frequency of myocardial infarction after blunt chest trauma as evaluated by radionuclide angiography.
        Am. J. Cardiol. 1983; 52: 1099
        • Svennevig J.L.
        • Bugge-Asperheim B.
        • Vaage J.
        • et al.
        Corticosteroids in the treatment of blunt injury of the chest.
        Injury. 1984; 16: 80
        • Weigelt J.A.
        • Norcross J.F.
        • Borman K.R.
        • et al.
        Early steroid therapy for respiratory failure.
        Arch. Surg. 1985; 120: 536

      Article info

      Publication history

      Accepted: December 16, 1986

      Identification

      DOI: https://doi.org/10.1016/0020-1383(87)90048-9

      Copyright

      © 1987 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX