Thoracic trauma: presentation and management outcome. J Coll Physicians Surg Pak. 2008 Apr;18(4):230-3. doi: 04.2008/JCPSP.230233. [PubMed] PMID:18474157 (original) (raw)
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Thoracic Trauma: Presentation and Management Outcome
Journal of the College of Physicians and Surgeons Pakistan Jcpsp, 2008
Objective: To determine the presentation and management outcome of thoracic trauma in a tertiary care setting. Patients and Methods: A total of 143 patients, who presented with chest trauma, were included in the study. All the patients were assessed by the history, physical examination and ancillary investigations. Appropriate managements were instituted as required. Data was described in percentages. Results: Out of 143 patients, 119 (83%) were males and 24 (17%) were females. Most of the patients belonged to the age group of 21-50 years. Ninety seven (66%) patients were admitted for indoor management. Blunt injury was found in 125 (87.4%) patients, while penetrating injuries in only 18 (12.6%) patients. Road Traffic Accidents (RTAs) were the commonest cause of trauma (n=103, 72%). Rib fracture was the commonest chest injury (74% patients). Head injury was the most frequently associated injury (18% of the patients). Tube thoracostomy was the commonest intervention undertaken in 65 (45 %) patients. Seventeen (11.88 %) patients were managed with mechanical ventilation. There were 17 deaths with a mortality rate of 11.88%. Conclusion: Thoracic trauma is an important cause of hospitalization, morbidity and mortality in the younger population. RTAs constitute the leading cause of thoracic trauma in our setup. Tube thoracostomy is the most frequent and at times the only invasive procedure required as a definitive measure in thoracic trauma patients. A policy of selective hospitalization helps to avoid unnecessary hospital admissions.
Thoracic Trauma: Analysis of 440 Cases
Kafkas Journal of Medical Sciences
Aim: Trauma still has a significant place among the reasons for death before the age of 40. This study analyzed the cases with thoracic trauma that were monitored at our center in a period of eight years. Material and Method: The study was conducted with 440 patients over the age of 16 (385 male, 55 female, mean age of 43.2 with a range of 17-89) who were treated at our center due to thoracic trauma in the period of 2011-2017. The patients were examined in terms of their age, sex, trauma etiology, clinical signs, accompanying injuries, surgery indications, applied surgical interventions, complications that occurred and mortality. Results: Three hundred and eighty five (87.5%) of our cases were male, 55 (12.5%) were female, and their mean age was 43.7 (17-89). While 202 (58.6%) of our cases with blunt thoracic trauma had isolated trauma, 143 (41.4%) had multiple traumas. 88 (92.6%) of our cases with penetrating thoracic trauma had isolated trauma, whereas there were multiple injuries in seven (7.4%). The reasons for blunt thoracic traumas were motor vehicle accidents, falling from a height, battery and injuries caused by cattle. Penetrating thoracic traumas were caused by firearms and injuries by sharp and pointed objects. Single and multiple rib fractures were the most frequent among bone structure injuries in the thorax. Pneumothorax had the first place among intrathoracic injuries. The most frequently applied surgical method for treatment was tube thoracostomy, while sternotomy was the least frequently applied method. Conclusion: The most significant accompanying problem that increases mortality in thoracic traumas are organ injuries. A patient with trauma should be systematically examined very fast, and unnecessary tests should be avoided.
Management of Thoracic Traumas: Analysis of 28 Patients
The International Annals of Medicine
Objectives: Trauma is the most common cause of death. Two parts 3 of all traumas are connected to the chest and the mortality is second after head injury. The purpose of this study is to determine the diagnosis, survival and treatment methods of chest traumas in a single-center. Methods: Between 01.08.2017 and 01.02.2018, all patients with thorax trauma admitted to the emergency service of our hospital and needed hospitalization were retrospectively reviewed with age, gender, additional systematic injuries, diagnosis, type of treatment, duration of hospitality. Results:17 male and 11 female patients were evaluated with ages ranging from 8 to 84 years (mean 39.6). There were 26 blunt and 2 penetrating injuries. Etiological factors were fall in 5(17%), motor vehicle accidents in 19, assault in 2, stab wound in 1and gunshot in 1 case. 10 patients had pneumothorax, 5 hemothorax, 19 rib fracture, 22 pulmonary contusion, 2 sternum fractures determined. 25 patients followed up conservatively, chest tube insertion applied in 2 patients and 1 patient underwent operation because of lung laceration. There were no mortality. Conclusions: Thoracic traumas are life threatening injuries and should be treated immediately. Identification and severe of injury is the guide of the treatment modality.
Thoracic Traumas: A Single-Center Experience
Turkish Thoracic Journal/Türk Toraks Dergisi, 2015
OBJECTIVES: Trauma is currently among the most important health problems resulting in mortality. Approximately 25% of traumarelated deaths are associated with thoracic trauma. In the present study, morbidity and mortality rates and interventions performed in patients who had been treated as inpatients in Dr. Siyami Ersek Thoracic and Cardiovascular Surgery hospital after trauma were aimed to be evaluated. MATERIAL AND METHODS: In our study, 404 patients who were treated as inpatients because of thoracic trauma between January 2005 and December 2008 were retrospectively evaluated. RESULTS: The rates of blunt and penetrating trauma were 39.6% and 60.4%, respectively. In the study, 115 (28.4%) patients were noted to have pneumothorax, 99 (24.5%) had hemothorax, and 57 (14.1%) had hemopneumothorax. While tube thoracostomy was sufficient for treatment in approximately 80% of the patients, major surgical interventions were performed in 12.6% of the patients. Mortality rate was found to be 2.2%. CONCLUSION: In patients with chest trauma, necessary interventions should be started at the time of the event, and the time from trauma to arriving at the emergency department should be made the best of. Mortality and morbidity rates in thoracic trauma cases may be reduced by timely interventions and effective intensive care monitoring.
MANAGEMENT OF THORACIC TRAUMA: EXPERIENCE AT AYUB TEACHING HOSPITAL, ABBOTTABAD.
Background: The incidence of thoracic trauma has rapidly increased in this century of high speed vehicles, violence and various other disasters. It has been observed that chest intubation was required in more than 75% of patients. Methods: This prospective study was performed in cardiothoracic surgery unit of Ayub Teaching Hospital Abbottabad from Jun 2007 to Dec 2007. A total of 114 consecutive patients with chest trauma were included in the study, their patterns of injuries classified, treatment strategies and outcome were recorded on a proforma. Results: Out of 114 patients with chest trauma, 76 (66.65%) were having penetrating and 38 (33.33%) had blunt trauma. Haemothorax was detected in 67 (58.77%), Pneumothorax in 23 (20.17%), rib fracture in 11 (15.02%) and diaphragmatic injuries in 4 (3.5%) cases. Overall complication rate was 14%. Wound infection was present in 8 (7.01%) and empyema in 4 (3.5%). Mortality was 2.6%. Conclusion: Penetrating chest injuries were more common than blunt injuries and chest intubation with resuscitation was adequate in most of the patients. Keywords: Chest Trauma, Penetrating chest injuries, chest intubation
Management of thoracic trauma in emergency service: Analysis of 1139 cases
Pakistan Journal of Medical Sciences, 2012
Objective: Thoracic trauma is a common cause of significant morbidity and mortality. This study presents a series of thoracic trauma with the aim to assess epidemiologic features, distribution of pathologies, additional systemic injuries, diagnosis, management and outcome. Methodology: Between January 2007 and December 2011, all patients with thorax trauma admitted to the emergency service of our hospital were retrospectively reviewed with respect to age, gender, etiological factors, distribution of pathologies, additional systemic injuries, diagnosis, treatment modalities, referral and outcome. Results: A total of 1139 patients with thorax trauma were included in the study. Of these, 698 (61.3%) were male and 441 (38.7%) were female, and the average age was 54.17±17.39 years. 1090 (95.7%) of the patients had blunt trauma, whereas 49 (4.3%) had penetrating trauma. Etiological factors were falls in 792 (69.5%), motor vehicle accidents in 259 (22.8%), animal related accidents in 39 (3.4%) and penetrating injuries in 49 (4.2%) patients. It was found that 229 (20%) patients had single, 101 (8.9%) had double, 5 (3%) had three or more, 10 (0.9%) had bilateral rib fractures and 19 (1.7%) had sternal fracture. Pneumothorax was diagnosed in 58 (5.1%) patients, whereas hemothorax, hemopneuomothorax and other system injuries were diagnosed in 36 (3.2%), 38(3.3%) and 292 (25.6%) respectively. In our series, thirteen patients (mortality rate 1.1%) died as result of hemorrhagic shock (n=8), respiratory distress (n=3) and severe multiple trauma (n=2). Conclusion: Although majority of the patients with thorax trauma receive treatment as outpatients; thoracic traumas may be a life threatening condition, and should be identified and treated immediately. Mortality varies based on etiological factors, additional systemic pathologies, capabilities of the hospital especially diagnostic and treatment facilities in emergency services. We believe that a multidisciplinary approach to the patients with severe thorax trauma, and the opportunities of emergency bedside thoracotomy in emergency services will significantly reduce the morbidity and mortality.
Our Experience in the Treatment of Severe Thoracic Trauma
Albanian Journal of Trauma and Emergency Surgery
Background: Severe thoracic trauma is main cause of deaths in US about 10-20 % of deaths. Causes of severe thoracic Trauma are :Penetrating trauma,Gunshot wounds,Stab wounds ;Lower mortality rate less massive, less multiorgan injury Gunshot wounds on the chest is the most lethal – 50% .Only 7-10% undergoes hospitalization prior to death .Death due to heart & great vessel injuries. Aim of study: Analyses of patients with Severe Thoracic Trauma ,Initial Evaluation and Management analyses of our cases period of time 2004-2017 treated in thoracic surgery service Material and methods: 95 patients are treated in our hospital during July 2004- July 2017 timeframe. Male to female was ratio 3:1. Age of presentation 9-71 years old, mean age presentation 49 years old. Blunt chest wall trauma 36 (38%) and penetraiting chest wall trauma 59 (62%) patients. Ribs and sternal fractures , two or more costal fractures in 15 (15.7%) patients (flail chest 7 patients );unilateral pneumothora...
Complications following thoracic trauma managed with tube thoracostomy
Injury-international Journal of The Care of The Injured
Tube thoracostomy is a common procedure used to treat traumatic chest injuries. Although the mechanism of injury traditionally does not alter chest tube management, complication rates may vary depending on the severity of injury. The purpose of this study was to investigate the incidence of and risk factors associated with chest tube complications (CTCs) following thoracic trauma.A retrospective chart review of all trauma patients (≥16 years old) admitted to an urban level 1 trauma centre (1/2007–12/2007) was conducted. Patients who required chest tube (CT) therapy for thoracic injuries within 24 h of admission and survived until CT removal were included. CTCs were defined as a recurrent pneumothorax or residual haemothorax requiring CT reinsertion within 24 h after initial tube removal or addition of new CT >24 h after initial placement. Variables including demographic data, mechanism, associated injuries, initial vital signs, chest abbreviated injury score (AIS), injury severity score (ISS), Glasgow coma score (GCS) and length of stay (LOS) and CT-specific variables (e.g. indication, timing of insertion, and duration of therapy) were compared using the chi square test, Mann–Whitney test, and multivariate analysis.154 patients were included with 22.1% (n = 34) developing a CTC. On univariate analysis, CTCs were associated with longer ICU and hospital LOS (p = 0.02 and p < 0.001), increased chest AIS (p = 0.01), and the presence of an extrathoracic injury (p = 0.047). Results of the multivariate analysis indicated that only increased chest AIS (OR 2.49; p = 0.03) was a significantly independent predictor of CTCs.CTCs following chest trauma are common and are associated with increased morbidity. The severity of the thoracic injury, as measured by chest AIS, should be incorporated into the development of CT management guidelines in order to decrease the incidence of CTCs.
Background: Thoracic injury accounts for 25 per cent of all severe injuries. Most patients who sustain thoracic trauma can be treated by technical procedures within the capabilities of clinicians trained in ATLS. This study was done to find out the incidence, causes, pattern of thoracic trauma, its diagnosis and management. Methods: This prospective study was conducted over a period of one year on patients reporting to casualty department of IGMC, Shimla with thoracic trauma. In all patients clinical assessment was done while concomitant resuscitation was performed as per ATLS protocol. Results: A total of 54 patients were enrolled in the study. Most common cause of injury was fall from height followed by road traffic accidents. The most common presentation was chest pain in 46 (85.2%) patients and tenderness over chest wall present in 38 (70.3%) patients. Rib fractures were present in 48 (88.8%) patients being the most common injury. Patients with associated injuries most commonly had liver injuries (25.9%). 10 (18.5%) patients were managed conservatively, 43 (79.6%) patients were managed with intercostal drainage and 1 (1.8%) patient underwent thoracotomy. Conclusions: Thoracic trauma is a major cause of morbidity in middle aged male population. Most chest injuries are treatable with simple procedures that is tube thoracostomy and thoracotomy is rarely required. The appropriate management of these patients is rapid and accurate assessment, resuscitation, stabilisation according to priorities as per ATLS protocol followed by timely appropriate intervention and close observation/monitoring.