A Review of 277 Cases of Patients with Chest Trauma in the Medical city Teaching Complex

Deparment of Surgery College Medicine University Medical City Teaching Complex. INTRODUCTION: Reports of chest injuries appeared as early as 3000 BC, in the Edwin Smith Surgical Papyrus ABSTRACT: BACKGROUND: Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. It represents 50% of all traumas. They are the cause of 25% of trauma deaths. OBJECTIVE: Describing the incidence, association with other injuries, understand the mechanism of common fatal injuries in chest trauma, diagnosis and operative morbidity and mortality. PATIENTS AND METHODS: A retrospective study of 277 patients, victims of chest trauma between August 2009 and August 2011 in Ghazi Al-hariri teaching surgical specialties hospital – Department of thoracic and vascular surgery/ medical city teaching complex. The records of all patients were reviewed and data were collected retrospectively. Management and follow up of the patients during hospitalization were evaluated. According to management patients were divided into two groups (conservative and surgical). RESULTS: Of 277 patients involved in this study 244(88.08%) of them were male and 33(11.91%) were female, with female /male ratio: (1/7.33). The majority of patients were in their third decade of life 100(36.10%) from 21-30 years. Penetrating chest trauma was seen in262 (94.58%) of the total number, 11(3.97%) had blunt chest trauma and 4(1.44%) had blunt and penetrating chest trauma. Bullets or shells in 205(74%), were the commonest penetrating injury, and commonest blunt trauma cause was blunt object in 8(2.88%) patients whereas 3(1.08%) patients due to RTA. The associated traumas were seen in 40.4% and the commonest one was limbs trauma in 57(20.57%) patients. The majority of the patients 219(79.06%) arrived to the hospital within hours of the injury mainly the first 4 hours. 190(68.59%) patients were treated as emergency cases and 87(31.40%) as cold cases. Chest x-ray performed to the all patients and the main radiological findings were haemothorax in 172 (62.1%). Conservative treatment in 37 (13.35%) patients and surgical treatment in 240 (86.64%) patients. The main Indication for thoracotomy was an initial drain more than 1500ml in 17(6.13%) patients, lung injuries were the commonest operative finding 29(10.46%). Hospital stay ranges from 1 day to 1 month and most of the patients 187(67.5%) discharged within the first 5 days of admission. Morbidity was seen in 19(6.85%) patients, wound infection was the commonest seen in 6(2.16%) patients, wound infection in 6(2.16%) patients, atelectasis in 5(1.8%) patients, respiratory distress syndrome in 4(1.44%) patients, CVA in 1(0.36%) patients, stress ulcer in 1(0.36%) patients, postoperative bleeding in 1(0.36%) patients and post intubation tracheal stenosis in 1(0.36%) patient. The overall mortality were 10(3.61%) patients, 2(0.72%) of them died perioperative were both of them they had associated injuries namely cardiac and central vessel injury respectively. All the 10 patients were male and the type of injury was penetrating in all. 8 out of 10 died had associated injuries. CONCLUSION: Penetrating chest injuries resulting from violence are the major public health problem in Iraq and bullets or shells are the commonest cause. Chest X-ray is diagnostic in most of cases. Associated injury should be carefully considered in the medical response strategies. The majority of patients with simple chest injuries can be managed by tube thoracostomy. Mortality is common with penetrating chest injuries.