Management of Blunt Chest Injury

Abstract

BACKGROUND Blunt chest injury is the most common thoracic injury. Although majority of the blunt chest injuries are benign, it can also result in many intrathoracic complications which requires prompt diagnosis and appropriate treatment. Injuries to the thoracic cavity or its contents require urgent intervention as a life-saving measure. METHODS This is a prospective observational study of 324 patients with blunt chest injuries from January 2015 to December 2018 in Regional Institute of Medical Sciences, Imphal. All patients with blunt chest injuries admitted in the Surgery ward and Orthopaedic ward with or without associated injuries were included in this study. Patients with penetrating chest injuries and patients with rib fracture who were not admitted in the ward were excluded from this study. Chest drain output of more than 1000 ml (at the initial drain), persistent air leak, and diaphragmatic rupture were considered as an indication for thoracotomy. Patients with minimal haemothorax or pneumothorax were managed conservatively with closed monitoring of vitals and follow up CT scan of the chest during the hospital stay. RESULTS A total of 324 patients (M=271, F=53) with blunt chest injuries were prospectively analysed. Mean age was 29 years (range 18-82 years). Majority of the patients were in the age group of 21 to 40 years comprising 177 (54.6%) patients (Table I). Road traffic accident (RTA) was the most common cause of blunt chest injuries comprising 88.9%. Rib fracture with or without associated haemothorax or pneumothorax was the most common injury (87.1%). This was followed by haemothorax (60.2%) and haemopneumothorax (5.9%). 11 (3.4%) patients presented with flail chest with varying amount of bilateral haemothorax. Traumatic asphyxia was the least common injury in patients with blunt chest injuries. CONCLUSIONS Blunt chest injuries carry a high morbidity and mortality risk if not managed with appropriate and urgent treatment. Tube thoracostomy is the main procedure performed in any chest injury. High index of suspicion is required for any intrathoracic organ involvement in management of chest injuries due to blunt trauma. Early decisions to perform surgical intervention can improve outcomes for patients with severe thoracic injury unnecessary.