Traumatic Chest Injuries Research Articles

Etiology of nosocomial infections and antibiotic resistance (level of antibiotic resistance) of identified pathogens in patients with traumatic chest injuries

Background. Chest injuries and wounds are common during armed conflicts, with frequent nosocomial infections and mortality up to 35-45% [1-4]. Infectious complications associated with multidrug-resistant microorganisms are an urgent issue in the management of patients with trauma. Aim. To conduct a retrospective review of the main causative agents of infectious complications in patients with traumatic chest injuries and evaluate antibiotic resistance of isolated pathogens. Materials and methods. Samples for microbiological examination were obtained from 160 patients with chest trauma and nosocomial complications. The samples included sputum, pleural fluid, bronchial washings obtained by fiberoptic bronchoscopy, and tracheal secretions. Antibacterial susceptibility tests were performed, and the antibiotic resistance mechanisms in isolated microorganisms were determined. Results. Gram-negative pathogens accounted for 93% of cases. The following organisms prevailed: Klebsiella pneumoniae – 42%, Acinetobacter baumannii – 28%, Pseudomonas aeruginosa – 18%, Escherichia coli – 9%. Of note, 91.4% of K. pneumoniae strains produced extended-spectrum β-lactamases and carbapenemases. The percentage of multidrug-resistant and pandrug-resistant strains was 48.2% and 52%, respectively. Conclusion. The data obtained indicate a wide spread of gram-negative microorganisms and their multiple resistance in patients with traumatic breast injuries complicated by nosocomial infection.

Thoracic Trauma: Diagnosis And Treatment

The study of chest injuries which profoundly impact quality of life, life expectancy, disability rates, and mortality is of significant importance. In clinical research, the authors analyzed diagnostic results from 527 patients aged 18 to 85 with closed chest trauma, consisting of 82% men and 18% women. The study confirms that traumatic chest injuries are severe conditions that necessitate strict adherence to well-defined diagnostic and treatment guidelines. It is advisable to utilize thoracoscopy and video-assisted thoracoscopy for managing hemothoraxes with small volumes of bleeding, as these minimally invasive techniques can enhance patient outcomes and reduce recovery times. The incorporation of advanced three-dimensional (3D) printing technologies into medical practice for chest injuries is also recommended, as it can improve surgical planning and enable personalized treatment strategies. Moreover, 3D printing can aid in the fabrication of patient-specific implants and prosthetics, thereby enhancing the effectiveness of reconstructive surgeries. Further research is needed on pharmacotherapy when using medications in accordance with the codes of the 11th revision of the International Classification of Diseases, to optimize therapeutic efficacy. Additionally, an in-depth study of the integrated ABC/VEN-analysis of drug prescriptions in pharmacotherapeutic regimens for thoracic trauma treatment dynamics in both inpatient and outpatient healthcare facilities is recommended. This could lead to better resource allocation, improved patient care, and the development of more effective treatment protocols. Emphasizing interdisciplinary collaboration among surgeons, radiologists, and pharmacologists is crucial to advance the management of chest trauma, ensuring that patients receive comprehensive and holistic care throughout their recovery process.

Analysis on short-term outcomes of patients with thoracic trauma at dr. Zainoel Abidin General Hospital in Banda Aceh

Background Thoracic trauma is defined as a trauma that hits the chest wall directly or indirectly, either as a result of blunt or penetrating trauma. Thoracic trauma can occur in any age or genders, and become a life-threatening if the treatment isn’t immediate and appropriate. Methods This research was an observational study with a cohort retrospective design using secondary data in the form of thoracic trauma patients at The Zainoel Abidin General Hospital, Banda Aceh, Indonesia in the period January 2019-December 2020. The statistical analysis used were chi square for bivariate and multivariate analysis, spesifically logistic regression analysis was conducted to know which risk factor influences the most. Result There were 141 medical records used in this study, thoracic trauma was more common in men compared to women. The age group of 46-55 is the age group with the highest percentage of thoracic trauma patients, road traffic are the leading cause of thoracic trauma where the most common diagnosis is rib fractures. Significant factors that associated with the short outcome of thoracic trauma are thoracic trauma diagnosis (p=0,00), management of thoracic trauma (p=0,00), ventilator (p=0,04), duration of ventilator (p=0.01), sepsis (p=0,00), qSOFA score (p=0,00) and injury severity score (p=0,00). Conclusions Vehicle accidents contributed to a considerable number of traumatic chest injuries in this study. Diagnosis, management of trauma, days of ventilation, qSOFA score, injury severity score, and development of sepsis were associated with the short-term outcome among thoracic trauma patients. Injury severity score seems to be the most influential variable in this study, the lower the better it is. Road safety intervention is urgently needed to control the underlying problems in this study.

Dexmedetomidine versus ketamine in improving tolerance to noninvasive ventilation after blunt chest trauma: A randomized, double-blinded, placebo-controlled trial

Abstract Background and Aims: Even though patient tolerance is critical to the success of noninvasive ventilation (NIV), research on using sedation to improve tolerance to NIV after traumatic chest injuries is limited. We hypothesized that dexmedetomidine would be superior to ketamine in terms of patient tolerance and lengthening the NIV sessions after blunt chest trauma. Material and Methods: This randomized, double-blinded, placebo-controlled trial included 45 patients of both genders aged 18–60 who needed NIV after blunt chest trauma. The patients were randomly assigned to one of three groups (n = 15) for receiving dexmedetomidine, ketamine, or placebo (0.9% sodium chloride solution) infusion to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and − 3 during two successive NIV sessions. Patients were evaluated for the duration of the NIV sessions, RASS, Visual Analog Scale (VAS), and the total amount of rescue analgesia consumed. Results: The mean duration of the NIV sessions was significantly longer in patients who received dexmedetomidine (P < 0.001) or ketamine (P < 0.001) compared to placebo. However, the NIV durations did not differ significantly between the dexmedetomidine and ketamine groups (P > 0.05). The dexmedetomidine group had a significantly lower RASS score compared to the ketamine (P < 0.001) and placebo (P < 0.001) groups, whereas the ketamine group had a significantly lower VAS compared to the dexmedetomidine (P = 0.005) and placebo (P = 0.022) groups and required significantly less total morphine (P = 0.001) compared to the other groups. Conclusion: The duration of the NIV sessions for patients with blunt chest trauma did not differ significantly between the dexmedetomidine and ketamine groups.

Outcomes of Video-assisted Thoracic Surgery-guided Early Evacuation of Traumatic Hemothorax: A Randomized Pilot Study at Level I Trauma Center.

Traumatic hemothorax is accounted for about 20% of traumatic chest injuries. Although majority can be managed with the timely placement of intercostal tube (ICT) drainage, the remaining pose a challenge owing to high complication rates associated with retained hemothorax. Although various treatment modalities including intrapleural instillation of fibrinolytics, radioimage guided drainage, VATS guided evacuation and thoractomy do exist to address the retained hemothorax, but indications along with timing to employ a specific treatment option is still unclear and ambiguous. Patient with residual hemothorax (>200 mL) on ultrasonography after 48 h of indwelling ICT was randomized into either early video-assisted thoracic surgery (VATS) or conventional approach cohort. Early VATS cohort was subjected to video-assisted thoracoscopic evacuation of undrained blood along with normal saline irrigation and ICT placement. The conventional cohort underwent intrapleural thrombolytic instillation for 3 consecutive days. The outcome measures were the duration of indwelling ICT, removal rate of tube thoracostomy, length of hospital stay, duration of intensive care unit (ICU) monitoring, need for mechanical ventilation, incidence of pulmonary and pleural complications, and requirement of additional intervention to address undrained hemothorax and mortality rate. The early VATS cohort had shorter length of hospital stay (7.50 ± 0.85 vs. 9.50 ± 3.03, P = 0.060), reduced duration of indwelling ICT (6.70 ± 1.25 vs. 8.30 ± 2.91, P = 0.127) with higher rate of tube thoracostomy removal (70% vs. 30%, P = 0.003) and lesser need of additional interventions (0% vs. 30%, P = 0.105). Thoracotomy (3 patients) and image-guided drainage (4 patients) were additional interventions to address retained hemothorax in the conventional cohort. However, similar length of ventilator assistance (0.7 ± 0.48 vs. 0.60 ± 1.08, P = 0.791) and prolonged ICU monitoring (1.30 ± 1.06 vs. 0.90 ± 1.45, P = 0.490) was observed in early VATS cohort. Both the cohorts had no mortality. VATS-guided early evacuation of traumatic hemothorax is associated with shorter length of hospital stay along with abbreviated indwelling ICT duration, reduced incidence of complications, lesser readmissions, and improved rate of tube thoracostomy removal. However, the duration of ventilator requirement, ICU stay, and mortality remain unchanged.

Traumatic Left Tension Pneumothorax with Concomitant Congenital Diaphragmatic Hernia

Blunt thoracic trauma carries a high risk of morbidity and mortality and may be life-threatening. Clinical identification of a tension pneumothorax necessitates immediate decompression. Diagnosing a diaphragmatic hernia in a trauma context is challenging and rather uncommon. Should both pathologies coexist, there is potential bowel perforation due to thoracocentesis. A traumatic chest injury can complicate patients with a congenital diaphragmatic hernia who are asymptomatic. Early identification with clinical assessment and bedside ultrasound is essential, and surgical repair is the definitive management. We report a case of traumatic left tension pneumothorax, prompting an immediate left thoracostomy and an incidental finding of an uncomplicated congenital diaphragmatic hernia.

Balloon Rises Above: REBOA at Zone 1 May Be Superior to Resuscitative Thoracotomy.

The use of Zone 1 REBOA for life-threatening trauma has increased dramatically. The Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database was queried for blunt and penetrating trauma between 2013 and 2021. Outcomes were examined both for mechanisms of injury combined and separately and for combinations of abdominal injury with and without traumatic brain injury and chest injuries (Abbreviated Injury Scale [AIS] score >2). A total of 531 patients underwent REBOA (408 with blunt injury and 123 with penetrating injury) and 1,603 (595 with blunt injury and 1,008 with penetrating injury) underwent resuscitative thoracotomy (RT). Mean age was 38.5 ± 16 years and mean injury severity score was 34.5 ± 21; 57.7% had chest AIS score of more than 2, 21.8% had head AIS score of more than 2, and 37.3% had abdominal AIS score of more than 2. Admission Glasgow Coma Scale was 4.9 + 4, and systolic blood pressure at aortic occlusion (AO) was 22 + 40 mmHg. No differences in outcomes in REBOA or RT patients were identified between institutions (p > 0.5). After inverse probability weighting, Glasgow Coma Scale, age, injury severity score, systolic blood pressure at AO, CPR at AO, and blood product transfusion, REBOA was superior to RT in both blunt (odds ratio [OR] 4.7, 95% CI 1.9 to 11.7) and penetrating (OR 4.9, 95% CI 1.7 to 14) injuries, across all spectrums of injury (p < 0.01). Overall mortality was significantly higher for AO more than 90 minutes compared with less than 30 minutes in blunt (OR 4.6, 95% CI 1.5 to 15) and penetrating (OR 5.4, 95% CI 1.1 to 25) injuries. Duration of AO more than 60 minutes was significantly associated with mortality after penetrating abdominal injury (OR 5.1, 95% CI 1.1 to 22) and abdomen and head (OR 5.3, 95% CI 1.6 to 18). In-hospital survival is higher for patients undergoing REBOA than RT for all injury patterns. Complete AO by REBOA or RT should be limited to less than 30 minutes. Neither hospital and procedure volume nor trauma verification level impacts outcomes for REBOA or RT.

Optimizing Chest Trauma Management: Strategies and Guidelines

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.&#x0D; 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.&#x0D; 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.&#x0D; 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.&#x0D; 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.&#x0D; Real-life case studies are presented to provide practical insights into chest trauma management, ensuring a comprehensive understanding of the topic.&#x0D; 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.&#x0D; 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.

Permanent pacemaker implantations among patients with spinal cord injury in the United States

Abstract Background Acute spinal cord injury (SCI) is associated with severe cardiovascular complications. Information regarding the need for permanent cardiac pacing in SCI patients is scarce and based on case reports and small case series. We aimed to investigate the extent of permanent pacemaker (PPM) implantation procedures as well as to identify predictors for PPM insertion among SCI patients in a U.S contemporary, nationwide, all-comer registry. Methods Using the National Inpatient Sample (NIS) database, patients hospitalized with a primary diagnosis of SCI in the US between 2016-2019 and underwent PPM implantation were identified. Patients with cardiac implantable electronic device in-situ were excluded. Baseline demographics, clinical characteristics, injury type, in-hospital procedures and outcomes including time to PPM implantation, length of stay and mortality were collected. Outcome analysis performed after propensity score matching (PSM). Predictors of PPM implantation were identified via a multivariable logistic regression model. Results A total of 35880 patients, were hospitalized with a primary diagnosis of SCI during the study period, and 240 (0.7%) received a PPM. Median age of patients receiving PPM was 69 years, 75% were males, and 67% had high level SCI injury (level C1-5). Time to PPM implantation was 9 days (IQR 4-19). PPM implantation was associated with higher rates of cervical spine injuries, traumatic brain injury (TBI), chest and upper limbs injuries, respiratory failure and other signs of severe illness. Longer hospital stay and higher in-hospital mortality rate was observed in patients receiving a PPM. Multivariate analysis identified the following independent risk factors for PPM implantation: cervical SCI [OR 77.07 (11.13-553.42), p&amp;lt;0.001], TBI [OR 3.84(1.59-9.28), p=0.003] and tracheostomy/respiratory ventilation&amp;gt; 96 h [OR 31.766(7.91-127.54), p=&amp;lt;0.001]. Conclusion Cervical SCI, need for tracheostomy and prolonged mechanical ventilation were the strongest predictors for PPM implantation in patients hospitalized for SCI in a nationwide registry.

Thoracostomy tube withdrawal during latter phases of expiration or inspiration: a systematic review and meta-analysis.

In patients with thoracic injuries, tube thoracostomy is routinely employed. There is disagreement over which manner of tube withdrawal is best, the latter phases of expiration or inspiration. Considering several earlier investigations' inconsistent findings, their comparative effectiveness is still up for debate. In light of this, we carried out a systematic analysis of studies contrasting the withdrawal of thoracostomy tubes during the latter stages of expiration versus inspiration for traumatic chest injuries. Analyzed outcomes are recurrent pneumothoraces, reinsertion of the thoracostomy tube, and hospital stay. We looked for papers comparing the withdrawal of the thoracostomy tube during the last stages of expiration and inspiration for the management of thoracic injuries on Embase, Pubmed, Cochrane Library and Google Scholar. Review Manager was used to determine mean differences (MD) and risk ratios (RR) using a 95% confidence interval (CI). The primary outcomes showed no significant difference between the inspiration and expiration groups: recurrent pneumothorax (RR 1.27, 95% CI 0.83-1.93, P 0.28) and thoracostomy tube reinsertion (OR: 1.84, CI 0.50-6.86, P 0.36, I2 5%). However, the duration of hospital stay was significantly lower in patients in whom the thoracostomy tube was removed at the end of inspiration (RR 1.8, 95% CI 1.49-2.11, P < 0.00001, I2 0%). The implications of these findings warrant cautious interpretation, accounting for potential confounding factors and inherent limitations that may shape their significance. The thoracostomy tube can be removed during both the end-expiratory and end-inspiratory stages of respiration with no appreciable difference. Nevertheless, caution should be exercised when ascertaining the implications of these findings, taking into account the potential limitations and confounding variables that may exert influence upon the outcomes.

Prehospital clinical practice guidelines for unintentional injuries: a scoping review and prioritisation process

BackgroundGlobally, millions of people die and many more develop disabilities resulting from injuries each year. Most people who die from injuries do so before they are transported to hospital. Thus, reliable, pragmatic, and evidence-based prehospital guidance for various injuries is essential. We systematically mapped and described prehospital clinical practice guidelines (CPGs) for injuries in the global context, as well as prioritised injury topics for guidance development and adolopment.MethodsThis study was sequentially conducted in three phases: a scoping review for CPGs (Phase I), identification and refinement of gaps in CPGs (Phase II), and ranking and prioritisation of gaps in CPGs (Phase III). For Phase I, we searched PubMed, SCOPUS, and Trip Database; guideline repositories and websites up to 23rd May 2021. Two authors in duplicate independently screened titles and abstract, and full-text as well as extracted data of eligible CPGs. Guidelines had to meet 60% minimum methodological quality according to rigour of development domain in AGREE II. The second and third phases involved 17 participants from 9 African countries and 1 from Europe who participated in a virtual stakeholder engagement workshop held on 5 April 2022, and followed by an online ranking process.ResultsFifty-eight CPGs were included out of 3,427 guidance documents obtained and screened. 39/58 (67%) were developed de novo compared to 19 that were developed using alternative approaches. Twenty-five out of 58 guidelines (43%) were developed by bodies in countries within the WHO European Region, while only one guideline was targeted to the African context. Twenty-five (43%) CPGs targeted emergency medical service providers, while 13 (22%) targeted first aid providers (laypeople). Forty-three CPGs (74%) targeted people of all ages. The 58 guidance documents contained 32 injury topics. Injuries linked to road traffic accidents such as traumatic brain injuries and chest injuries were among the top prioritised topics for future guideline development by the workshop participants.ConclusionThis study highlights the availability, gaps and priority injury topics for future guideline development/adolopment, especially for the African context. Further research is needed to evaluate the recommendations in the 58 included CPGs for possible adaptation to the African context.

Epidemiology and outcomes of traumatic chest injuries in children: a nationwide study in the Netherlands

Thoracic injuries are infrequent among children, but still represent one of the leading causes of pediatric mortality. Studies on pediatric chest trauma are dated, and little is known of outcomes in different age categories. This study aims to provide an overview of the incidence, injury patterns, and in-hospital outcomes of children with chest injuries. A nationwide retrospective cohort study was performed on children with chest injuries, using data from the Dutch Trauma Registry. All patients admitted to a Dutch hospital between January 2015 and December 2019, with an abbreviated injury scale score of the thorax between 2 and 6, or at least one rib fracture, were included. Incidence rates of chest injuries were calculated with demographic data from the Dutch Population Register. Injury patterns and in-hospital outcomes were assessed in children in four different age groups. A total of 66,751 children were admitted to a hospital in the Netherlands after a trauma between January 2015 and December 2019, of whom 733 (1.1%) sustained chest injuries accounting for an incidence rate of 4.9 per 100,000 person-years. The median age was 10.9 (interquartile range (IQR) 5.7–14.2) years and 62.6% were male. In a quarter of all children, the mechanisms were not further specified or unknown. Most prevalent injuries were lung contusions (40.5%) and rib fractures (27.6%). The median hospital length of stay was 3 (IQR 2–8) days, with 43.4% being admitted to the intensive care unit. The 30-day mortality rate was 6.8%.Conclusion: Pediatric chest trauma still results in substantial adverse outcomes, such as disability and mortality. Lung contusions may be inflicted without fracturing the ribs. This contrasting injury pattern compared to adults underlines the importance of evaluating children with chest injuries with additional caution.What is Known:• Chest injuries are rare among children, but represent one of the leading causes of pediatric mortality.• Children show distinct injury patterns in which pulmonary contusions are more prevalent than rib fractures.What is New:• The proportion of chest injuries among pediatric trauma patients is currently lower than reported in previous literature, but still leads to substantial adverse outcomes, such as disabilities and death.• The incidence of rib fractures gradually increases with age and in particular around puberty when ossification of the ribs becomes completed. The incidence of rib fractures among infants is remarkably high, which is strongly suggestive for nonaccidental trauma.

Delayed Aortic Valve Perforation Caused by Blunt Trauma.

Traumatic aortic regurgitation (AR) is a rare complication of blunt chest trauma. We described the case of a 35-year-old male who presented to our hospital with shortness of breath 7 years after sustaining blunt chest trauma associated with a motorcycle accident. Transthoracic and transesophageal echocardiogram detected severe AR with two separate jets. The patient was diagnosed with congestive heart failure due to severe AR, and surgical aortic valve replacement was performed. A large perforation of the right coronary cusp likely sustained during the initial blunt chest trauma injury was confirmed surgically. As AR caused by blunt chest trauma can gradually worsen, it is necessary to confirm if there is a history of trauma in patients with severe AR of unknown origin.

Platelet dysfunction after trauma: From mechanisms to targeted treatment.

Platelet dysfunction after trauma: From mechanisms to targeted treatment.

Analysis on short-term outcomes of patients with thoracic trauma at dr. Zainoel Abidin General Hospital in Banda Aceh

Background: Thoracic trauma is defined as a trauma that hits the chest wall directly or indirectly, either as a result of blunt or penetrating trauma. Thoracic trauma can occurred in any age or genders, and become a life-threatening if the treatment isn’t immediate and appropriate. Methods: This research was an observational study with a cohort retrospective design using secondary data in the form of thoracic trauma patients at The Zainoel Abidin General Hospital, Banda Aceh, Indonesia in the period January 2019- December 2020. The statistical analysis used were chi square for bivariate and multivariate analysis, spesifically logistic regression analysis was conducted to know which risk factor influences the most. Result: There were 141 medical records used in this study, thoracic trauma was more common in men compared to women. The age group of 46-55 is the age group with the highest percentage of thoracic trauma patients, road traffic are the leading cause of thoracic trauma where the most common diagnosis is rib fractures. Significant factors that associated with the short outcome of thoracic trauma are thoracic trauma diagnosis (p=0,00), management of thoracic trauma (p=0,00), ventilator (p=0,04), duration of ventilator (p=0.01), sepsis (p=0,00), qSOFA score (p=0,00) and injury severity score (p=0,00). Conclusions: Motorbike accidents contributed to a considerable number of traumatic chest injuries in this study. Diagnosis, management of trauma, days of ventilation, qSOFA score, injury severity score, and development of sepsis were associated with the short-term outcome among thoracic trauma patients. Injury severity score seems to be the most influential variable in this study, the lower the better it is. Road safety intervention is urgently needed to control the underlying problems in this study.

“Packing” torácico en urgencias torácicas

Damage control is defined as an approach with 3 stages in patients with life-threatening injuries. Stage I: abbreviated laparotomy for hemorrhage and contamination control. Stage II: intensive care management to correct physiologic abnormalities; and stage III: definitive repair of injuries. Thoracic packing, an adaptation of abdominal packing, was described as a temporary procedure for hemostatic control. The aim of this study is to report our experience with thoracic packing and show its usefulness in thoracic damage control surgery. Traumatic chest injuries vary from minor trauma to life-threatening injuries. The decision to perform thoracic packing is made during the contact with a critically ill patient. In conclusion, packing is effective for bleeding control in critically ill patients who are not suitable for definitive treatment.

Mortality rate and factors associated with death in traumatic chest injury patients: A retrospective study

BackgroundTraumatic chest injury is responsible for 10%–15% of all trauma-related hospital admissions across the world. It is also responsible for approximately 25% of trauma related death. Several predictors have been described for mortality following chest trauma however, limited published studies were available in Ethiopia. ObjectiveTo assess mortality rate and factors associated with death in traumatic chest injury patients over five year's period from June 2016 to June 30, 2020 G.C. MethodA retrospective cross-sectional study was done from June 2016 to June 30, 2020. Data was collected from patients’ chart. The collected data was entered into Epi-info version 7 and transferred to SPSS version 20.0 for processing and analysis. Bivariable and multivariable logistic regression was used to show factors associated with mortality. P- Value < 0.05 was considered statistically significant. ResultA total of 419 patient charts were eligible for this study. The majority of patients (55.8%) sustained blunt chest injuries and violence (52.5%) was the leading cause of injuries. Hemopneumothorax (27.7.0%), hemothorax (22.9%) and rib fracture (17.2%% were the most common type of injuries. Associated extra-thoracic injuries were noted in 70.4% of patients, from those, extremity injury (22.2%), head/neck injuries (21.7%) and abdominal injuries (18.1%) were the commonest. Most patients (64.7%) were treated successfully with chest tube. Nearly, one third (35.3%) had complications including pneumonia (13.8%) and Atelectasis (12.6%). The mean length of hospital stay was 9.40 days. The overall traumatic chest injury mortality rate was 26%. Mortality was significantly associated with age >50 year [AOR 9.32, 95% CI, 2.72–31.86], late presentation beyond 6hr (AOR 7.17, 95% CI 1.76–29.21), bilateral chest injury (AOR 3.58 95% CI 1.53–8.38), penetrating chest injury (AOR 3.63 95% CI 1.65–7.98), presence of extra-thoracic injury (AOR 4.80, 95% CI, 1.47–15.72) and need for mechanical ventilation (AOR 11.18, 95% CI 2.11–59.23). ConclusionThe mortality rate in traumatic chest injury was high. Late presentation beyond 6hr, age >50-year, penetrating injury, bilateral chest injury, associated extra thoracic injury, and need for mechanical ventilation were identified as possible risk factors for mortality in traumatic chest injury patients.

Retrospective Statistical Study of Thoracic Trauma Patients in Al-Hussein Hospital, Al-Azhar University

Background: Trauma is reported to be the leading cause of death. Thoracic trauma comprises 10-15% of all traumas. Thoracic trauma directly accounts for approximately 25% of trauma related mortality and is a contributing factor in another 25%. Eastern Mediterranean region had one of the highest rates of trauma mortalities around the world. Objective: to determine chest trauma cases as regards the pattern, etiology, type of chest trauma, management and outcome of chest trauma in Al-Hussein Hospital, Al-Azhar University. Patients and methods: A retrospective study was done on one hundred patients with traumatic chest injuries admitted to Al-Hussein Hospital, Al-Azhar University and were randomly chosen. Data were collected from patient’s files. Results: The highest incidence of thoracic trauma was found in age groups of 3rd and 4th fourth decades. The cause of trauma was work related; 42%, assault; 31%, road traffic accident; 20% respectively. Forty seven percent of cases had open cardiothoracic injury, 26% had closed lung injury and hemothorax, and 18% had chest cage fracture while 9% had pneumothorax only. Conclusion: Assault related injury was found to be the commonest cause of chest trauma followed by road and motor car accident, which could be explained by characters of population activities in the area surrounding Al-Hussein hospital.

A rare case scenario: spontaneous diaphragmatic rupture during labor

Diaphragmatic rupture during labor is not a very common presentation and usually occurs in patients with prior history of traumatic chest or abdominal injury or any congenital abnormality. We presented a case of a 29 year old woman who presented with sudden breathing difficulty two days after a full-term delivery by caesarean section. e-FAST scan suggested the presence of a massive pleural effusion over right side. CT scan of chest revealed large rent in right diaphragm with superior migration of liver and hepatic flexure. Patient was taken for emergent surgical intervention, inter coastal drainage (ICD) tube was placed and surgical repair was performed, patient was further treated in critical care unit, the patient recovered well and was discharged. Though diaphragmatic hernia rupture during labor are not reported often it is life threatening complication that requires immediate surgical intervention to prevent major complications and mortality.

DIAGNOSIS AND TREATMENT OF THORACIC INJURIES AND TRAUMATIC HEMOPNEUMOTHORAX

Purpose: The purpose of the study is to analyze the diagnosis and treatment of patients with traumatic chest injuries and traumatic hemopneumothorax in UMHATEM "N. I. Pirogov ". Material and Methods: Data on 113 patients with thoracic trauma were processed within a retrospective clinical analysis for the period of 1.1. 2016 to 1.1. 2018 in the General, Visceral and Emergency Surgery Section of the UMHATEM "Pirogov. Of the hospitalized women are 38 (33.63%), men 75 (66.37%). The age in this retrospective analysis varied from 18 to 83 years (average 57.4 years). Results: In our study, among 113 patients, 43 patients had a pneumothorax, 29 patients were with hemothorax, 18 patients with hemopneumothorax, 2 patients had tension pneumothorax and others 21 had only rib fractures. Associated injuries were confirmed in 43 patients (38.05%). From all patients group, 21 patients were managed conservatively, 89 patients with chest tube insertion and only 3 with thoracotomy. Conclusions: The majority of the patients with a thoracic injury can be performed in emergency surgery by conservative management or by mini-intervention- thoracic chest tube. Tube thoracostomy was evaluated to be important for pleural collections from blunt or penetrating trauma. Therefore it was recommended as a first-line therapeutic approach.