Invited Critique |

The Broken Chest:  Comment on “Factors Associated With Survival Following Blunt Chest Trauma in Older Patients”

Pardon R. Kenney, MD
Arch Surg. 2010;145(5):437-438. doi:10.1001/archsurg.2010.72.
Text Size: A A A
Published online


Harrington et al have described factors affecting survival following blunt chest trauma in patients older than 50 years. While a laudable attempt to pool retrospective data from 8 large trauma centers, the article raises numerous questions that unfortunately are incompletely answered.

Since its inception, the Advanced Trauma Life Support course has stressed flail chest with pulmonary contusion as 1 of 6 life-threatening chest injuries whose identification is mandatory in the primary survey of the injured patient.1 The authors collected information on this subset of patients and have inferred that prolonged intubation may have been a “surrogate marker” for pulmonary contusion. However, other than this, their analysis is largely silent about the effect of these more severe injuries on mortality. It is difficult to interpret the results of this study without knowing the mortality of their patients with flail chest with pulmonary contusion. Put another way, we know that these patients are at high risk in the first place, and if they were eliminated from the analysis, would the conclusions of the article remain the same?

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles