Changes in the patterns, presentation and management of penetrating chest trauma patients at a level II trauma centre in Southern Pakistan over the last two decades

Abstract

Penetrating chest trauma can be used as an indicator of violence in the country. We aimed to look at the changes in its incidence and management at a major trauma centre in the country. We also wanted to look at any effect of prehospital time on surgical intervention and outcome of the victim. In this retrospective descriptive study, we observed the presentation and management of 191 penetrating chest injury patients at a level II trauma hospital in Pakistan in the last 20 years. The study sample was divided into two groups: Group 1, 1988-1998 and Group 2, 1999-2009. No significant change in incidence of trauma was observed between the two groups. The delay in the time between event and arrival showed an increase in the number of surgical procedures performed. Also the number of thoracotomies performed went up significantly in the second decade from 5.7 to 16.5% with a P<0.05. Six (3.1%) mortality cases were observed in 20 years. It was seen that the greater the prehospital time, the greater the chances of surgery. Also seen was the increase in mortality as critical cases could make it to the hospital alive in recent times due to improved transportation services.

Penetrating Chest Injuries.

“…Res. 4(10), 1318-1321 1319 Penetrating thoracic trauma is mostly attributed to violence and has a higher mortality rate than blunt trauma (2,6). It is more common in men due to their propensity to violence and the mechanism of injury is usually a gunshot wound or stab wound.…”

“…It is more common in men due to their propensity to violence and the mechanism of injury is usually a gunshot wound or stab wound. Early recognition and timely treatment of life-threatening injuries, better resuscitative techniques, preoperative care, and elective surgical procedures can significantlyaffect outcomes in these patients (2). Studies have shown chest tube thoracostomy to be the primary modality for managing nonmediastinal, peripheral chest injury, with a very low incidence of thoracotomy (2,7).…”

“…Thoracic injury is a common cause of mortality and major disability, and it is the leading cause of death in the rst 3 decades of life (1,2). thoracic injuries account for 20%-25% of deaths due to trauma (2,3).…”

“…thoracic injuries account for 20%-25% of deaths due to trauma (2,3). Penetrating thoracic trauma accounts for almost 33% of total chest traumas (2).…”

“…thoracic injuries account for 20%-25% of deaths due to trauma (2,3). Penetrating thoracic trauma accounts for almost 33% of total chest traumas (2). The population has suffered increasing rates of penetrating trauma, with such trauma thus becoming a public health problem, associated with increasing levels of violence in society (4,5).…”