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 30 mg/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.(ABSTRACT TRUNCATED AT 250 WORDS)