Epidemiology, Complications, and Management of Chest Trauma: A Cross-Sectional Study at Shar Teaching Hospital, Iraq

Aim: In this study, we aimed to determine the safety and feasibility of tube thoracostomy in the management of chest trauma and its impact on patient outcomes. Material and Methods: This retrospective study was conducted at the Department of Surgery, Northern Medical Tower, in Arar Kingdom of Saudi Arabia for 2 years from January 2019 to December 2020. Inclusion criteria were patients who presented to the Emergency Department with chest trauma due to a motor car accident (MCA), history of falls, history of assault, etc., and they were hemodynamically stable. Exclusion criteria were hemodynamically unstable patients with obvious signs of thoracotomy. Records of all patients with chest trauma were retrieved from files. The variables of the study were the demographic data, the mechanism of trauma, the clinical assessment of patients, the duration of the chest tube, length of stay in the hospital, complications, and clinical outcomes. Result: This study included 365 patients with chest trauma, 329 (90.14 %) males and 36 (9.86%) females with a ratio of M 9:1 F. The age of the patients ranged from 12 to 70 years with a mean age of (41.15 1.5) years. Road traffic accidents were the commonest mechanism in 300 (82.19%) patients with blunt chest trauma and a stab wound in penetrating chest trauma. Head and neck injuries were the most common associated injuries. Tube thoracostomy under local anesthesia was done in 98 (27%) patients, while 267 (73%) patients were managed conservatively. Discussion: Tube thoracostomy is a safe and feasible option in the management of chest trauma with better patient outcomes. Chest trauma resulting from road traffic accidents remains the major mechanism of chest injury among young males and active age groups.

Thoracic trauma can be a life-threatening condition and should be dealt with as an emergency. All medical professionals dealing with trauma should be familiar with the identification, diagnosis, and management of chest trauma. The establishment of major trauma centres ensures that cardiothoracic surgical specialists are involved in the care of these patients. Although the chest injury can be the fatal injury, it should be taken within the context of other life-threatening injuries (e.g. head/pelvic injuries). Chest injury can also be less obvious than other external more obvious injures and the clinician should maintain a high index of suspicion for associated chest injury based on the nature and history of the trauma. In the management of chest trauma, emphasis should be placed on the damage control resuscitation and damage control surgery working as a continuum, with attention to the environment, equipment and the expertise available to manage the specific condition.

Trauma is the leading cause of death worldwide. Approximately 2/3 of the patients have a chest trauma with varying severity from a simple rib fracture to penetrating injury of the heart or tracheobronchial disruption. Blunt chest trauma is most common with 90% incidence, of which less than 10% require surgical intervention of any kind. Mortality is second highest after head injury, which underlines the importance of initial management. Many of these deaths can be prevented by prompt diagnosis and treatment. What is the role of the thoracic surgeon in the management of chest trauma in severely injured patients? When should the thoracic surgeon be involved? Is there a place for minimal invasive surgery in the management of severely injured patients? With two case reports we would like to demonstrate how the very specific knowledge of thoracic surgeons could help in the care of trauma patients.

PurposeThis study aims to describe the epidemiology and management of chest trauma in our center, and to compare patterns of mechanical ventilation in patients with or without associated moderate-to-severe traumatic brain injury (TBI).MethodsAll children admitted to our level-1 trauma center from February 2012 to December 2018 following chest trauma were included in this retrospective study.ResultsA total of 75 patients with a median age of 11 [6–13] years, with thoracic injuries were included. Most patients also had extra-thoracic injuries (n = 71, 95%) and 59 (79%) had TBI. A total of 52 patients (69%) were admitted to intensive care and 31 (41%) were mechanically ventilated. In patients requiring mechanical ventilation, there was no difference in tidal volume or positive end-expiratory pressure in patients with moderate-to-severe TBI when compared with those with no-or-mild TBI. Only one patient developed Acute Respiratory Distress Syndrome. A total of 6 patients (8%) died and all had moderate-to-severe TBI.ConclusionIn this small retrospective series, most patients requiring mechanical ventilation following chest trauma had associated moderate-to-severe TBI. Mechanical ventilation to manage TBI does not seem to be associated with more acute respiratory distress syndrome occurrence.

The role of minimal invasive surgery in management of chest trauma should not be underestimated. The amount of data for video-assisted thoracoscopic surgery (VATS) management in chest-trauma patient is rare. Nevertheless the on-going acceptance and use of VATS for major thoracic resections has led to advanced techniques for management of major bleedings in the elective-surgery-patient. VATS as a procedure for pleural space management in the non-critical, non-massive-transfusion patients can be of great assistance. Its value in persistent non-major-vessel-bleeding hemothorax in terms of pleural space debridement is unchallenged. In some cases VATS is considered to be related to lower ARDS-rates in comparison to open thoracotomy patients, whereby an obvious bias for the non-massive-injury-patients exist. Jin et al. could prove a significant advantage for stable thoracic trauma patients treated through VATS in a randomised trial vs. open thoracotomy.

A comparison of rigid -v- video thoracoscopy in the management of chest trauma

This abstract was published in Volume 110, Supplement 10, December 2023 ASGBI Emergency General Surgery Symposium. 1st November 2023. Glasgow, UK, and can be accessed at https://academic.oup.com/bjs/article/110/Supplement_10/znad388.012/7455140

Chest tube insertion (CTI) is a vital procedure in the management of chest trauma and pleural diseases. Challenges associated with CTI often stem from an inadequate understanding of relevant anatomy and unsafe procedural practices. Despite is importance, there is a noticeable lack of data on the current state of CTI competence and knowledge among medical students and interns in Saudi Arabia. This study aims to investigate the knowledge and competency of CTI among medical students and interns in Saudi Arabia. In 2024, a cross-sectional study was conducted among medical students and interns across various locations in Saudi Arabia. Data were collected through a comprehensive questionnaire that evaluated participants' knowledge, practical experience, training and education, as well as their attitudes and beliefs regarding CTI. A total of 413 medical students and interns in Saudi Arabia participated in the study, with 58.1% currently in their clinical years (Years 4-5). The findings revealed that only 35.6% demonstrated adequate knowledge about CTI. Regarding training and education, 53.5% of participants believed that the instruction they received on CTI was sufficient. Additionally, the majority (61.0%) expressed a positive attitude towards CTI, recognising its importance. However, a striking 88.4% reported having no experience performing a CTI independently, with the most commonly reported challenge being "insufficient practice opportunities" (73.6%). The results emphasize the necessity for targeted education to address knowledge deficits and enhance procedural competency, thereby improving clinical safety.

Introduction: Chest trauma is one of the main causes of mortality among polytrauma patients, requiring immediate intervention to prevent worsening of clinical conditions. Injuries such as tension pneumothorax, massive hemothorax, and cardiac tamponade must be quickly identified for effective decisions. Objective: To analyze the main strategies adopted in the management of chest trauma in hospital emergency services, focusing on the application of structured protocols, rapid assessment, bedside examinations, and procedures adapted to contexts with limited resources. Justification: Given the high prevalence and severity of these injuries, understanding the most effective clinical practices is essential to reduce mortality and strengthen emergency medical training. Method: Integrative review of the literature in databases such as PubMed, SciELO, LILACS, Embase, and Scopus, with publications between 2015 and 2025, in Portuguese, English, and Spanish. Results and Discussion: The application of the ATLS protocol, the use of e-FAST and tomography, when available, demonstrated efficacy in reducing mortality. In contexts with few resources, qualified clinical triage and trained teams proved to be essential. Conclusion: A rapid, structured response adapted to the institutional setting is crucial for the success in the management of thoracic trauma.

Aim Audit the management of chest trauma in a District General Hospital according to guidelines set by the regional major trauma centre (MTC). Methods Patients admitted with traumatic rib fractures over a six-month period were included. Clinical notes and imaging were reviewed. Primary outcomes were chest injury severity score (CISS), pain team review and referral to MTC. Secondary outcomes included 30-day readmission and mortality. Results 37 patients were included and only 2 had a CISS calculated on admission. Scores were retrospectively calculated with 89.2% scoring over 11 – the threshold for admission and aggressive management. 28 (75.7%) of patients met the criteria for referral to the MTC for consideration of rib fixation but only 8 were referred. 27 (73.0%) were seen by the pain team and 16 patients received a nerve block. There were 5 patients (13.5%) readmitted within 30 days of discharge with complaints of pain or dyspnoea. 3 were discharged from the emergency department, 2 required an additional inpatient stay. There were 2 deaths (5.4%) within 30 days of discharge. Cause of death was only available for 1 patient who had died of pneumonia. Conclusion Chest trauma has a high morbidity and is often managed by emergency general surgeons in centres without cardiothoracic services. Clear management guidance is vital to improving outcomes. As a result of this audit the trust’s pathway for chest trauma has been updated and new tools developed on our electronic patient record system to facilitate calculation of the CISS and completing the necessary referrals.

Introduction; Chest trauma, resulting from both blunt and penetrating mechanisms, poses a significant health threat, and its management demands precise strategies and adherence to established guidelines. This presentation introduces a comprehensive presentation on optimizing chest trauma management, delving into essential strategies and guidelines for healthcare professionals.
 The presentation begins by outlining the various types and mechanisms of chest trauma, such as blunt and penetrating injuries, with a focus on their significance and prevalence in healthcare settings.
 Subsequently, the initial assessment of chest trauma patients takes center stage. This involves a primary survey encompassing airway assessment and management, breathing assessment and intervention, circulation assessment and resuscitation, disability assessment, and environmental control. It continues with a secondary survey, including history-taking and a detailed physical examination, accompanied by diagnostic modalities like chest X-rays, computed tomography scans, ultrasound, and arterial blood gas analysis.
 The presentation then proceeds to address specific chest trauma injuries, including rib fractures, flail chest, pneumothorax, hemothorax, cardiac injuries, pulmonary contusion, and tracheobronchial injuries. The various management approaches are discussed, ranging from pain management, oxygen therapy, chest tube placement, surgical interventions, cardiac tamponade management, to controlling massive hemorrhage.
 Additionally, it highlights complications and outcomes related to chest trauma, including long-term effects, rehabilitation, and follow-up. The critical role of prevention, pre-hospital care, and guidelines and protocols such as Advanced Trauma Life Support (ATLS) and those from the Eastern Association for the Surgery of Trauma (EAST) are emphasized.
 Real-life case studies are presented to provide practical insights into chest trauma management, ensuring a comprehensive understanding of the topic.
 In conclusion, the abstract emphasizes the significance of early recognition, appropriate management, and continuous education and training in chest trauma cases to optimize patient outcomes.
 This presentation offers a holistic perspective on chest trauma management and equips healthcare professionals with the knowledge and tools to enhance the care provided to patients with chest trauma.

Aim of the study: To describe the management of patients with chest trauma in the ICU of National Hospital of Niamey (HNN). Patients and Method: It was a retrospective descriptive analytical study carried out from February 1st, 2017 to February 28th, 2021, ie 4years. Were included in the study, all the patients with chest trauma admitted in the ICU of National Hospital of Niamey. The studied variables included: age, gender, medical history, the circumstances of occurrence, the mecanism involved, transport, time to admission, type of the trauma, associated lesions, clinical signs, complementary signs, medical care of the patient, surgical care of the patient, evolution and length of stay in hospital. The collected data were entered and analized with the following software : EPI Info v3.5.4, Office 2019. Results: During the time of our study we have registered 34 patients over 982 patients who were hospitalized ; ie a frequency of 3.46%. We’ve noted a male predominance with 73.52% (n=25) ; ie a sex ratio of 2.77. The average age of our patients was 32.14 years with extremes ranging from 1 to 70 years. The age group of 31 to 45 years was the most affected with 64.70% (n=22). Twenty six (26) patients, ie 76.5% had no medical history, 5 had hypertension, 2 were diabetics and 1 was a chronic smoker. The etiologies were dominated by road accidents with 61.76% (n=21) followed up by ballistic trauma with 17.64% (n=6). We noted close chest trauma in 76.47% (n=26) of the cases and open chest trauma in 23.53% (n=8) of the cases. The patients benefited from medical transport (SAMU) in 35.29% (n=12) of cases. The average time to admission was 3.8 hours. Hemothorax was the most frequent lesion with 26.47% (n=9), followed up by pneumothorax with 20.58% (n=7) and ribs fracture with 17.64% (n=6). The most frequent associated lesions were limbs fracture with 26.47% (n=9), abdominal trauma with 23.52% (n=8) and head trauma with 20.58% (n=7). Fifty percent (50%) of our patients had ...

Cardiovascular injuries after trauma present with high mortality. The aim of the study was to present our experience in cardiac and great vessel injuries after chest trauma. During the 10-year period, 104 patients with cardiac (n=94) and great vessel (n=10) injuries presented to our hospital. The demographic data, mechanism of injury, location of injury, other associated injuries, timing of surgical intervention, surgical approach, and clinical outcome were reviewed. Eighty-eight (84.6%) males presented after chest trauma. The mean age of the patients was 32.5±8.2 years (range: 12-76). Penetrating injuries (62.5%) were the most common cause of trauma. Computed tomography was performed in most cases and echocardiography was used in some stable cases. Cardiac injuries mostly included the right ventricle (58.5%). Great vessel injuries involved the subclavian vein in 6, innominate vein in 1, vena cava in 1, and descending aorta in 2 patients. Early operations after admission to the emergency were performed in 75.9% of the patients. Thoracotomy was performed in 89.5% of the patients. Operative mortality was significantly high in penetrating injuries (p=0.01). Clinicians should suspect cardiac and great vessel trauma in every patient presenting to the emergency unit after chest trauma. Computed tomography and echocardiography are beneficial in the management of chest trauma. Operative timing depends on hemodynamic status, and a multidisciplinary team approach improves the patient's prognosis.

The management of chest trauma

During a 6-year period, 188 patients with chest wall trauma were admitted to the Royal Adelaide Hospital Intensive Care Unit. One hundred and sixty one patients were treated with thoracic epidural analgesia using bupivacaine 0.5% with adrenaline 1/200,000. One hundred and forty seven (91%) were treated conservatively; previously 100% of patients had been treated with mechanical ventilation. Two patients died from severe respiratory failure. Serious side effects associated with epidural analgesia included two cardiac arrests and one epidural infection. Conservative management of chest wall trauma relies largely upon the effectiveness of the pain relief. If complete plain relief is provided then the conservative approach is more likely to be successful. While epidural analgesia can provide complete relief from pain it is not without hazard.