Thoracic Traumas: A Single-Center Experience

Abstract

OBJECTIVES:Trauma is currently among the most important health problems resulting in mortality. Approximately 25% of traumarelated deaths are associated with thoracic trauma. In the present study, morbidity and mortality rates and interventions performed in patients who had been treated as inpatients in Dr. Siyami Ersek Thoracic and Cardiovascular Surgery hospital after trauma were aimed to be evaluated. MATERIAL AND METHODS:In our study, 404 patients who were treated as inpatients because of thoracic trauma between January 2005 and December 2008 were retrospectively evaluated. RESULTS:The rates of blunt and penetrating trauma were 39.6% and 60.4%, respectively. In the study, 115 (28.4%) patients were noted to have pneumothorax, 99 (24.5%) had hemothorax, and 57 (14.1%) had hemopneumothorax. While tube thoracostomy was sufficient for treatment in approximately 80% of the patients, major surgical interventions were performed in 12.6% of the patients. Mortality rate was found to be 2.2%. CONCLUSION:In patients with chest trauma, necessary interventions should be started at the time of the event, and the time from trauma to arriving at the emergency department should be made the best of. Mortality and morbidity rates in thoracic trauma cases may be reduced by timely interventions and effective intensive care monitoring. KEYWORDS: Trauma, thorax, morbidity, mortality INTRODUCTIONThoracic traumas have a wide spectrum from simple rib fractures to major vascular injuries. Traumas are the major cause of death in individuals younger than 40 years [1]. Approximately 50% of deaths following trauma are directly or indirectly associated with thoracic trauma [2]. However, recently published studies have reported a decrease in mortality rates related to thoracic trauma. Glinz [3] reported that 10% and 18% of 460 trauma-related deaths are directly and indirectly related to thoracic trauma, respectively.Penetrating injuries are less common than blunt trauma in thoracic trauma patients, and mortality after penetrating injuries is lower than that after blunt traumas. However, mortality rate varies according to the trauma mechanism and organ damage after trauma. While mortality rate is between 1% and 8% after stab wounds, the rate is between 14% and 20% after gunshot wounds. Mortality is higher in patients with cardiac injury. Mortality rate rises to 25-28% in case there is diaphragmatic, pulmonary, or large vessel injury after trauma [2]. The pathological process after thoracic trauma is associated with respiratory and hemodynamic changes. The most common pathology observed is hypoxia. Hypoxia occurs because of reasons such as bleeding, collapse, or compression of the lung, respiratory or cardiac failure, pulmonary contusion, intrathoracic pressure change, and mediastinal shift.Chest X-ray is the first and most valuable diagnostic tool to reveal the pathology after thoracic trauma and to determine the treatment approach. Computed tomography helps reveal the pathologies that cannot be determined by the chest X-ray.Supportive or sur...