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Category: Volume 07 Issue 11 November 2019
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Title: Prospective Study of Blunt Trauma Chest

Authors: Piyush K. Sinha, Kapil Sindhu, Ashish K Chaudhary, Ashutosh Bawa, Minal Panwar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.76

Abstract

Introduction: Trauma is a major cause of morbidity and mortality in both developed and developing countries. Globally 10% of all trauma admissions results from chest injury and 25% of trauma related deaths are attributed to chest injuries. Chest trauma may present as isolated injury or as a part of polytrauma. The incidence of chest injuries are on a rise, with motor vehicle accidents (MVA) playing the most important role. Chest trauma can be broadly divided into two categories: blunt chest injuries & penetrating chest injuries. Blunt trauma chest is often associated with injuries to other organs, especially the abdominal solid organs as the upper part of the abdomen is overlapped by the thoracic cage. Very few studies have been conducted to analysis the magnitude and management of blunt chest trauma in Indian scenario.

Aim & Objectives: To study the clinical profile of cases with blunt trauma chest in reference to mode of injury, hospital stay, diagnosis, severity of injury, treatment offered morbidity and mortality.

Material & Methods: A prospective, observational, clinical study was conducted at Department of Surgery, MMIMSR, Mullana, and Ambala. Consecutive type of non-probability sampling was used for the selection of study subjects during study duration. A total of 50 consecutive cases fulfilling the eligibility criteria were taken for study after informed consent. Data was collected from these patients admitted in surgical wards and ICU. All the patients admitted with provisional diagnosis of blunt trauma chest were admitted in surgical ward/ ICU. Data was analyzed using statistical software SPSS ver. 21.

Results: Mean age of the subjects with blunt chest trauma was 33.32 years with almost two third of cases belonging to 18-40 years of age (64%). Male predominance was seen among study cases with 74% males to 26% females. Mode of injury was road traffic accident in 54% cases while it was fall in 34% cases. Decelerated injury was observed in 76% cases while polytrauma was seen in 36% cases. Most common presenting symptom was chest pain (92%) followed by dyspnoea (82%), abdominal pain (24%), nausea/vomiting (22%). Surgical/ Subcutaneous Emphysema was observed in 32% cases. Hemothorax, pneumothorax and Pneumo-hemothorax was seen in 52%, 26% and 12% cases respectively. As per injury severity score, low to medium severity injury was observed in 66% and 22% cases respectively. Severe injury was seen in 12% cases. As per injury severity score, low to medium severity injury was observed in 66% and 22% cases respectively. Severe injury was seen in 12% cases. Conservative management was sufficient in 36% cases while remaining cases required surgical intervention. Tube thoracotomy was required in 62% while mechanical ventilation was seen in 36% cases. Laparotomy was required in 20% cases. Pneumonia developed in 10% cases while pyothorax and septicaemia was seen in 4% and 8% cases respectively. Acute renal failure and Multi-organ dysfunction was seen in 1 case each.   Increased injury severity score was associated with poly-trauma patients (p<0.01). Mean hospital and ICU stay was more in polytrauma cases as compared to isolated chest trauma cases (p<0.05). Incidence of Mortality was 4% in present study.

Conclusion: Blunt trauma chest is more common among the young males. Increased outdoor activities and vehicular accidents are responsible for increased blunt trauma chest. The commonest injury was rib fracture followed by hemothorax and pneumothorax. The most common associated injury was clavicle fracture while most common abdominal solid organ injury was that of liver. About two third cases required tube thoracotomy while 36% of cases were managed conservatively. Pneumonia was the most common complication encountered followed by septicaemia and pyothorax. The overall mortality rate in this series was 4%. The determinant of severe injury was polytrauma which leads to increased hospital/ ICU stay.

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Corresponding Author

Kapil Sindhu

Assistant Professor, Dept. of Surgery, MMIMSR, Mullana Ambala 133207