European Journal of Cardiovascular Medicine

Traumatic chest injury is common in emergencies and they cause high morbidity and mortality globally. Chest injuries are caused by mechanisms like road traffic accidents, falls, assault, and industrial accidents, and by far the most frequent mechanism in most settings is motor vehicle collisions (Zhang et al., 2021) [3]. Chest trauma may range from solitary soft tissue bruising to severe injuries like flail chest, hemothorax, and tension pneumothorax (Walia et al., 2021) [2].

Management of chest trauma is due to the vital organs contained in the thoracic cavity. Management of chest trauma is based on the type of injury, whether there are injuries to other systems, and the facilities available, involving commonly the collaborative efforts of several specialties (Chrysou et al., 2017; Potey et al., 2020) [1,4]. Early diagnosis and prompt treatment of chest trauma are vital for enhancing outcomes. It's especially true for patients with multiple injuries where chest trauma can complicate resuscitation and recovery (Vodička et al., 2016) [5,6].

In low-resource nations, waiting time in accessing medical care, inadequate pre-hospital care, and wasted time in patient processing can worsen the case (Thomas & Ogunleye, 2009) [8]. Paediatric chest trauma, as rare as it may be, also poses its own challenges due to the variations encountered in anatomy and physiology as noted in studies involving children (van As et al., 2013) [7].

We shall examine the clinical presentation, management guidelines, and outcomes of patients with traumatic chest injuries at a tertiary hospital in the hope of providing additional evidence for the report of best practice in trauma care.

Study Design and Setting

This was a prospective observational study in a tertiary care center. It was performed on all patients with an impact of blunt thoracic trauma seen in the General Surgery, CTVS and Orthopaedics during the time frame period of one year between March 2020 and February 2021.

Inclusion and Exclusion Criteria

We included all the thoracic trauma patients admitted during the timespan of the study. Patients who were admitted dead on arrival or dead on arrival in terminal cardiac arrest were excluded from the study. In order to limit our selection to patients who were actually being managed and were able to evaluate their outcomes.

Data Collection and Clinical Assessment

All patients underwent full clinical examination starting with the trauma protocol, a primary and secondary survey. The primary survey indicated injuries to the ABCs, and a thorough physical examination was completed to observe the extent of any thoracic injuries or associated problems.

Investigations and Diagnostics

Based on the clinical presentation and findings of the patient, radiological studies were obtained. Chest X-rays, ultrasonography (FAST), and CT scans together with relevant hematological and biochemical investigations were considered in order to assist diagnosis and plan further management.

Management Approach 

In the Emergency Departments we have provided interventions including oxygen therapy, chest tubes, analgesia and fluid resuscitation as needed. If patients required surgical intervention, surgical services treated them. Associated injuries to the musculoskeletal or abdominal systems were treated and/or consulted for by other specialists.

Follow-Up and Outcome Assessment 

Throughout their hospital stay, patients were closely monitored. We documented data on complications, the length of hospital stays, the need for intensive care, and final outcomes, including morbidity and mortality. We tracked the clinical course and treatment responses for all cases included in the study.

Data Analysis 

The data we collected were analyzed using descriptive statistical methods. We expressed the results in terms of frequency, percentages, means, and standard deviations where applicable, to assess patterns in injury mechanisms, management strategies, and clinical outcomes.

A total of 70 patients with traumatic chest injuries were included in this study. The findings are presented below using summarized tables and graphical representations to highlight key demographic characteristics, types and mechanisms of injury, management strategies, and outcomes.

Table 1: Demographic and Clinical Profile of Patients

The majority of patients were young males in their 20s and 30s, with blunt trauma being the predominant injury type.

Figure 1: Distribution of Mechanism of Injury

Note: Road traffic accidents were the leading cause, followed by physical assaults.

Table 2: Types of Injuries and Management

Rib fractures and hemothorax were the most frequent findings. Chest tube drainage was the most commonly used therapeutic intervention.

Figure 2: Pie Chart Showing Patient Outcomes

Most patients recovered well, although a small proportion experienced complications or mortality, mainly associated with severe trauma or polytrauma.

The study produced significant clinical data evaluations. The overall mortality rate of this study was 5.7% due to major thoracic injury and secondary head injuries. There were complications found in 19.3% of patients, which included empyema, localized insertion site infection, chronic chest pain. The average length of stay in hospital was 8.9 days. Of the 46 patients followed up, almost all of the patients returned to their original baseline, although some continued complaints of symptoms, which eventually resolved with conservative management. Overall, this study showed the burden of blunt thoracic injury, particularly from road traffic accidents; and it substantiates the need for prompt chest tube drainage and operative management, to optimize the overall outcomes of blunt thoracic trauma patients.

The present research provides an extensive account of traumatic chest injuries in a tertiary care setting, and stresses the high incidence of blunt trauma (particularly from road traffic accidents (RTAs)) and the necessity for timely surgical interventions. Similar to the findings of Al-Koudmani et al., our results also showed that RTAs were responsible for the majority of chest injuries (57.8%) and also indicating that it was the leading cause of thoracic trauma in lower income settings [10].

In regard to gender, 8.4% of patients were female, which represents a significant male preponderance (10.6:1 male-female ratio), similar to the findings of Saaiq and Shah who found a similar gender distribution and attributed it to higher potential exposure to avocations and occupational hazards experienced by men [11]. The average age of patients was roughly 31 years, consistent with the findings of Mathangasinghe et al., where most chest trauma victims fell within their third to fourth decades of life [15]. This demographic trend underscores the vulnerability of the economically active population to traumatic injuries.

Blunt chest trauma made up 80% of the cases in our study, closely mirroring the findings of Sanidas et al., who stressed the importance of early recognition and conservative management for such injuries at the primary care level [13]. Rib fractures were the most common thoracic injury we encountered (68.6%), a result that aligns with the reports from Ahsan et al. and Martins et al., who also identified rib fractures as a key feature of thoracic trauma [12,14].

Intercostal water seal drainage (ICWSD) was the most frequently performed procedure, accounting for 77.1%, which aligns with global best practices in managing thoracic trauma. Our rate of surgical interventions and the relatively low use of thoracotomy at 10% mirrors findings from Lalwani et al., who highlighted the success of conservative management and minimally invasive techniques in most thoracic trauma cases [9].

In our study, the mortality rate stood at 5.7%, mainly due to severe injuries or accompanying head trauma. This figure is quite similar to previous studies, like the 6.4% mortality noted by Al-Koudmani et al., reinforcing the significant impact of associated injuries—especially head trauma—on patient outcomes [10]. The incidence of complications including empyema and wound infections was observed in 19.3% of cases reported, which is consistent with the complication rates of Saaiq and Shah [11].

In conclusion, this study provides evidence from both regional and global literature that blunt thoracic trauma resulting from road traffic accidents (RTAs) will continue to be a major threat to trauma care services. Identifying the injury quickly, inserting a tube, and facilitating appropriate surgical intervention will be essential for management; both outcome and management effectiveness are subject to the influence of associated injuries and speed in the chain of injury care provided.

Ultimately chest trauma as a cause of morbidity and mortality is considerable, particularly in young adult males, with road traffic collisions being the most common cause. The number of blunt thoracic injuries indicated the need for timely assessment and intervention, particularly with intercostal chest drainage, which remains the best first line management.While many cases were handled successfully with conservative or minimally invasive methods, the presence of additional injuries, like those to the head or abdomen, had a significant impact on the outcomes. Timely diagnosis, sound surgical choices, and diligent follow-up care are crucial for minimizing complications and boosting survival rates in patients dealing with thoracic trauma.

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