Retrospective evaluation of laboratory and imaging findings of chest trauma patients admitted to the emergency department of Süleyman Demirel University

Objective: The aim of our study is to evaluate the relationship of the frontal QRS-T (FQRS-T) angle and the index of cardiac electrophysiological balance (ICEB) with diagnostic imaging findings in patients admitted to the emergency department due to thoracic trauma, and to assess the prognostic value of these parameters in relation to morbidity and mortality. Materials and Methods: This study was designed as a retrospective, randomized, observational, single-center study conducted at the Emergency Medicine Department of Süleyman Demirel University Faculty of Medicine. Medical records of patients aged 18 years and older who presented to the emergency department of Süleyman Demirel University Research and Training Hospital between 01.09.2022 and 01.09.2023 and were diagnosed with pneumothorax (J93), hemothorax (J94.2), rib fracture (S22.3), or thoracic contusion (S20.2) were reviewed. Patients with complete data were included. Demographic information (age, sex, date of admission), vital signs, laboratory parameters (WBC, NE, LY, MO, HGB, PLT, MPV), inflammatory markers (NLR, MLR, SII, SIRI, AISI), and electrocardiographic parameters were recorded into case report forms. Results: The mean age of the patients was 47.74±20.38 years. Statistically significant differences were found between survivors and non-survivors in trauma mechanism, admission unit, diagnosis, presence of pneumothorax and hemothorax, number and location of rib fractures (p<0.01). Vital signs including GCS, temperature, heart rate, SpO2, respiratory rate, systolic and diastolic blood pressure also showed statistically significant differences (p<0.01). Laboratory values such as WBC, NE, MO, HGB, NLR, SII, SIRI, and AISI were also significantly different between groups (p<0.01). Statistically significant differences were also observed in QTc interval, FQRS-T angle, and ICEB values (p<0.01). Among the parameters for predicting pneumothorax, the highest AUC values were found for SpO2 (AUC: 0.754) and ICEB (AUC: 0.714). For predicting mortality, the highest AUC values were again SpO2 (AUC: 0.778) and FQRS-T angle (AUC: 0.745). Cox regression analysis revealed that each categorical increase in the FQRS-T angle increased mortality risk by 1.036 times. Similarly, each unit decrease in ICEB increased the risk of mortality by 2.7 times. A violin plot analysis was used to assess ICEB distribution among diagnostic groups, and the ICEB median value was found to be significantly lower in patients with pneumothorax (p=0.019). Logistic regression analysis demonstrated that each unit decrease in ICEB increased the likelihood of pneumothorax by 4.347 times. Conclusion: This study demonstrated that electrocardiographic parameters such as ICEB and the FQRS-T angle are significant predictors of mortality and pneumothorax in patients with thoracic trauma. Decreased ICEB and increased FQRS-T angle were identified as strong predictors of both reduced survival and clinical deterioration. These findings suggest that both parameters may be useful for early risk stratification and prognostic assessment in trauma patients. Keywords: pneumothorax, FQRS-T, ICEB, mortality