Prehospital physiological parameters associated with acute thoracic intervention in patients with thoracic trauma: a retrospective single-centre cohort study

Abstract Purpose Thoracic trauma can cause life-threatening respiratory and hemodynamic compromise. We examined associations between prehospital physiological parameters and acute thoracic intervention in patients with thoracic trauma. Methods This retrospective TraumaRegister DGU® cohort study was conducted at a level I trauma centre (2018–2022). Adults with thoracic trauma were included; patients undergoing prehospital cardiopulmonary resuscitation were excluded. Thoracic intervention comprised prehospital decompression and/or emergency department chest tube placement. Logistic regression and receiver operating characteristic analyses were performed. Results Among 387 patients, 104 (26.9%) underwent intervention. In the primary model (n = 317), lower oxygen saturation (SpO₂) (adjusted odds ratio [OR] per percentage-point increase, 0.949; 95% confidence interval [CI], 0.913–0.986) and penetrating trauma (adjusted OR, 9.163; 95% CI, 2.735–30.699) were associated with intervention. In the exploratory alternative model (n = 277), higher respiratory rate was also associated with intervention (adjusted OR per breath/min, 1.071; 95% CI, 1.010–1.135); associations with SpO₂ and penetrating trauma persisted. SpO₂ discrimination was limited (area under the curve, 0.610; 95% CI, 0.540–0.680). Conclusion Lower SpO₂ and penetrating trauma were associated with thoracic intervention in the primary model; higher respiratory rate was additionally associated in the exploratory alternative model. Because SpO₂ had limited discriminatory ability, it should not be used alone to guide decisions about thoracic intervention.