Pattern and Outcome of Thoracic Injuries in a Busy Tertiary Care Unit

Abstract

Introduction: Thoracic traumas are one of the most commonly encountered injuries in the emergency room. They range from blunt chest injuries due to road traffic accidents to penetrating chest injuries. Immediate medical and surgical interventions are essential to improve the outcome. This study was conducted to assess the pattern of thoracic trauma presenting to the emergency room, their outcome and factors contributing to it. Methods: This prospective, observational, cross-sectional study was conducted in the Department of Thoracic Surgery, Jinnah Post Graduate Medical Center, Karachi from January 1 until July 31, 2020, with institutional ethical approval. Patients age ≥12 years presenting with traumatic thoracic injury with or without associated injuries were included. Characteristics of their injuries and management outcome were studied. All data was processed through Statistical Package for Social Sciences (SPSS) Statistics version 22 (IBM Corp., Armonk, NY, USA). Results: A total of 199 patients were included; 154 (77.4%) patients were male and 45 (22.6%) patients were female. The most common age group presenting with trauma was the middle age (30-60 years), which included 101 (50.8%) patients. Out of the total, 126 (63.3%) had blunt chest injuries and 73 (36.6%) had penetrating chest injuries. Road traffic accidents were the most common cause of blunt chest injuries seen in 83 (65.8%) patients, whereas gunshot was the most common mode of penetrating chest injuries encountered in 41 (56.2%) cases. Tube thoracostomies were performed in 166 (83.4%) patients and thoracotomies in seven (3.51%) patients. Out of the total, 57 (28.6%) patients required mechanical ventilation and it was associated with blunt trauma, hemothorax, rib fracture, abdominal and head injuries (p ≤0.05). Mortality was seen in 22 (11.1%), which was associated with hemothorax, head injuries, mechanical ventilation and severe blood loss (p ≤0.05). Conclusion: Traumatic thoracic injuries are a preventable cause of mortality. Blunt chest injuries are more common than penetrating chest injuries. Proper implementation of public safety measures ensures less frequent and severe outcomes. Emergency department team and specialized thoracic surgeons must come together to manage these critical patients with utmost care.