Traumatic asphyxia: A clinical evaluation

From December 1991 through January 1997, 28 cases with clinical evidence of traumatic asphyxia were treated at our hospitals. They all presented with thoracoabdominal blunt trauma and varying degrees of cervicofacial cyanosis, petechiae and subconjunctival hemorrhage. There were 16 male and 12 female patients. The injury severity score (ISS) ranged from 3 to 58 with most patients having scores of less than 10 (50%). There were no deaths among those with ISS<20, but a high mortality rate (20%) was found in patients with ISS>20. Seven patients had low Glasgow Coma Scale scores (GCS>9), in whom six patients recovered consciousness within 24 hours. The mechanisms of injury included being run over or struck by motor-vehicles (15), crushed by roller machines at work (7), compressed by a heavy weight (5), and falling from a height (1). Associated injuries included rib fractures (8), lung contusions (5), hemo-pneumothoraxes (4), long bone fractures (4), pelvic fractures (2), intracranial hemorrhages (2), brachial plexus neuropathy (2), and liver or spleen lacerations (2). Two patients eventually died. One had a severe lung contusion and subsequent respiratory failure; the other suffered from an intracerebral hemorrhage and an ensuing upper gastrointestinal bleeding. In this series, the prognosis following traumatic asphyxia was good, even in patients with initially low GCS scores. The mortality rate was related to the associated organ injuries.