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Profile of Chest Trauma in a Referral Hospital: A Five-Year Experience

Department of Cardiothoracic Surgery 1 Department of Anaesthesia Sri Venkateswara Institute of Medical Sciences Tirupati, Andhra Pradesh, India

For reprint information contact: Raju S Iyer, MCh Tel: 91 422 21 1000 Fax: 91 422 21 3509 email: gknmh{at}vsnl.com G Kuppuswamy Naidu Memorial Hospital, Department of Cardiothoracic Surgery, P. O. Box 6327, Pappanaickenpalayam, Arinashi Road, Coimbatore, Tamil Nadu 641037, India.

From April 1993 to March 1998, 90 patients with chest injuries were retrospectively assessed for the incidence, presentation, and outcome of thoracic trauma. The majority (55.6%) were less than 40 years of age and 83 (92%) were male. The mode and extent of injury, specific intrathoracic organ injuries, associated injuries, flail chest, ventilatory requirements, management, morbidity, and mortality were analyzed. Blunt injuries were seen in 56 (62.2%) and penetrating injuries in 34 (37.7%). Multiple rib fractures with hemopneumothorax was the most frequent presentation with orthopedic and head injuries being most commonly associated. Patients with tachypnea, cyanosis, lung contusion, partial pressure of aterial oxygen less than 60 mm Hg, and those with more than 6 rib fractures most often required ventilation but the majority (54.4%) were treated with a chest drain only. Emergency or delayed thoracotomy was required in 24.4%. The mortality rate was 6.7%, mainly due to respiratory insufficiency. Subcutaneous emphysema requiring releasing incisions accounted for most of the morbidity. Mean hospital stay was 9.5 days. Chest injuries were of major concern in multisystem trauma patients and early planned management is recommended in a mostly vulnerable section of our population in an age of violence and vehicular accidents.