Delayed diagnosis of flail chest

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Abstract
A retrospective review of 99 consecutive patients with flail chest after trauma was conducted to determine the incidence and significance of delayed presentation. Patients ranged in age from 7 to 88 yr (mean 50.3). Hospitalization ranged from 1 to 129 days (mean 23). Mean Injury Severity Score was 30. Sixty (61%) patients were managed with mechanical ventilation. Pulmonary complications developed in 48 (48%) patients and 14 (14%) patients died. The flail chest injury was documented on initial examination of 77 (78%) patients. Delayed presentation occurred in 22 (22%) patients from 1 to 10 days after injury. Reasons for delayed diagnosis included intubation and mechanical ventilation before complete physical examination, development of pulmonary complications with the attendant increased work of breathing, and physician error. The time of presentation was not associated with patient age, sex, severity of injury, need for mechanical ventilation, duration of ventilation, incidence of pulmonary morbidity, or mortality. (Crit Care Med 1990; 18:611)

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