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Ahmed K, Al-Hassani A, El-Menyar A, Nabir S, Ahmed MN, Almadani A, Mahmood I, Mekkodathil A, Peralta R, Rizoli S, Al-Thani H. Time to resolution of radiologically detected hemothorax in trauma patients: A retrospective observational study. World J Radiol 2025; 17:105960. [PMID: 40309476 PMCID: PMC12038407 DOI: 10.4329/wjr.v17.i4.105960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Revised: 03/15/2025] [Accepted: 03/26/2025] [Indexed: 04/22/2025] Open
Abstract
BACKGROUND Traumatic hemothorax is a common complication of chest trauma; however, the timeline for its resolution, even with chest tube thoracostomy, remains unclear. AIM To determine the time to resolution of the hemothorax to ensure safe discharge based on chest radiography (CXR) findings. METHODS A retrospective observational study was conducted at Hamad General Hospital, Qatar, from June 2014 to October 2019, including all patients with hemothorax diagnosed via computed tomography (CT) following chest trauma. Based on the initial imaging study, the hemothorax was divided into right, left, and bilateral. RESULTS The study included 422 patients. Of the total, 57.82% (n = 244/422) resolved their hemothorax within three days of admission. Among these, 44 patients required chest tube insertion (CTI) and 200 were cleared without it. Between days 3 and 7, an additional 16.83% (n = 71 /422) of cases were resolved, of which 28 required chest tubes. By days 8 to 14, another 11.37% (n = 48/422) were cleared, with 15 patients requiring chest tubes. After 14 days, 13.98% (n = 59/422) of patients still had hemothorax, 14 of whom required CTI. CONCLUSION This study showed that a subset of patients continued to experience retained hemothorax despite early tube thoracostomy. Patients with a larger hemothorax, particularly on the left side, showed prolonged resolution times. Regular imaging such as CXR or CT is recommended for up to 14 days post-intervention. After this period, outpatient follow-up is generally safe, although some patients may still have a persistent hemothorax beyond two weeks.
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Affiliation(s)
- Khalid Ahmed
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Ammar Al-Hassani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma, and Vascular Surgery, Doha 24144, Qatar
- Clinical Medicine, Weill Cornell Medical College, Qatar Foundation-Education City, Doha 24144, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Ammar Almadani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Ismail Mahmood
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | | | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha 3050, Qatar
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo 10100, Dominican Republic
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha 3050, Qatar
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AlSulaiman RS, Al Abbas SM, Alshaikh ZA, Almoallem GS, AlOqayli FA, Alibrahim LO, Abu Abdullah LA, Elbawab HY. Causes and Pattern of Chest Trauma Among Adults: A Scoping Review of Studies From the Middle East. Cureus 2023; 15:e49980. [PMID: 38077676 PMCID: PMC10698296 DOI: 10.7759/cureus.49980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/31/2025] Open
Abstract
Chest trauma incidence is increasing worldwide, and it requires attention as it is a major cause of morbidity and mortality. Worldwide, chest trauma is the second most common cause of mortality and a major cause of disability and hospitalization. Our main aim is to systematically review the prevalence, pattern, causes, manner, morbidity, and mortality of chest trauma in the Middle East among adults. This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Screening of the relevant articles was done by using databases, including PubMed, Scopus, and Web of Science. A total of 128 articles were found as a result of searching the databases and reviewing the reference lists. Finally, nine articles met the inclusion criteria. Most of the victims were males, as reported by all studies in this systemic review. The most common cause of chest trauma was road traffic accident (RTA), as described in seven out of the nine included studies. The pattern of chest trauma included pneumothorax, hemothorax, hemopneumothorax, lung contusion, flail chest, rib fracture, and diaphragmatic injury. The rate of mortality and morbidity following chest trauma varied among the studies. However, most of the studies revealed higher rates of morbidity than mortality. Chest trauma carries economic and social burdens, and it is a serious issue, especially in males in the second to third decades. Preventive measures should be considered to decrease the prevalence of chest trauma and its related complications.
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Affiliation(s)
- Reem S AlSulaiman
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, SAU
| | - Safia M Al Abbas
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, SAU
| | - Zahra A Alshaikh
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, SAU
| | - Ghadeer S Almoallem
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, SAU
| | - Fatimah A AlOqayli
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, SAU
| | - Laila O Alibrahim
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, SAU
| | - Layla A Abu Abdullah
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, SAU
| | - Hatem Y Elbawab
- Surgery/Thoracic Surgery, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, SAU
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Okoye OG, Olaomi OO, Adamu YB, Anumenechi N. Thoracic trauma in national hospital Abuja, Nigeria: The epidemiology, injury severity and initial management options. Afr J Emerg Med 2023; 13:15-19. [PMID: 36700166 PMCID: PMC9852269 DOI: 10.1016/j.afjem.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/16/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
Background Trauma is the leading cause of death in individuals between the ages of 1 and 44 years and it is the third commonest cause of death regardless of age. Thoracic trauma is a relatively common cause of preventable death among trauma patients. The spectrum of injuries after blunt chest trauma presents a challenging problem to the emergency physician. This study is intended to discuss the epidemiology, severity and initial management strategies in chest trauma patients, in a low income country. Methods A cross sectional retrospective study among chest trauma patients seen in the emergency room of National Hospital Trauma Centre, Abuja, Nigeria, from January 2015 to December 2017. Relevant patients' information was retrieved from the trauma registry kept in the trauma centre. Data processing and analysis was done using statistical package for social sciences (SPSS) version 24. Test of significance was done where applicable using chi square and student t test, using p value less than 0.05 as significant. Results are presented in tables and figures. Results A total of 637 patients, male to female ratio of 3.6 and mean age of 34.18 ± 11.34 were enrolled into the study. The most common mechanisms of injury were MVC (54.6%) and assault (23.5%). Blunt injuries were 3.5 times more frequent than the penetrating injuries. The RTS of 12 (76.3%) and the ISS of 1-15 category (52.3%) were the most common scores. Up to 98% of patients were managed non-operatively. Recovery rate was high (89%) with relatively low mortality rate of 4.2%. Conclusion Majority of thoracic trauma can be managed effectively by employing simple, non-operative procedures such as needle decompression and chest tube insertion. Efforts should be made to include these procedures in the skill set of every medical officer working in the emergency room, particularly in low and middle income countries where there is paucity of emergency physicians.
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Affiliation(s)
- Onyedika Godfrey Okoye
- Trauma Centre, Department of Surgery, National Hospital Abuja, Central Business District, Garki, Abuja, Nigeria
- Corresponding author.
| | - Oluwole Olayemi Olaomi
- Trauma Centre, Department of Surgery, National Hospital Abuja, Central Business District, Garki, Abuja, Nigeria
| | - Yahaya Baba Adamu
- Cardiothoracic Division, Department of Surgery, National Hospital Abuja, Nigeria
| | - Ndubisi Anumenechi
- Cardiothoracic Division, Department of Surgery, National Hospital Abuja, Nigeria
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Sikander N, Ahmad T, Shaikh KA, Abid A, Mazcuri M, Nasreen S. Analysis of Injury Patterns and Outcomes of Blunt Thoracic Trauma in Elderly Patients. Cureus 2020; 12:e9974. [PMID: 32850270 PMCID: PMC7445091 DOI: 10.7759/cureus.9974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction In the elderly population, trauma is a leading cause of utilization of healthcare, institutionalization, disability, and mortality. In this study, we will assess the injury patterns and the factors associated with the outcomes of blunt thoracic trauma in elderly individuals. Methods This prospective observational study was conducted in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from September 2019 to April 2020. The study included patients of both genders aged 60 years and above with blunt thoracic trauma. Patients with concomitant neurological injuries and penetrating trauma to the chest were excluded. Results There were a total of 80 patients in this study; majority were males (n = 66 [82.5%]). The mean age was 70.18 ± 8.3 years. Road traffic accident was the most common mode of injury (n = 45 [56.3%]) followed by fall (n = 32 [40%]). Hemothorax and hemopneumothorax were the most common primary diagnosis. Rib fractures were encountered in 72 (90%) patients. Mortality rate was 21.3% (n = 17). Factors significantly related to mortality were age ≥ 80 years (p = 0.00), tension pneumothorax (p = 0.036), pre-existing cardiopulmonary disease (p = 0.032), blood loss ≥ 500 mL (p = 0.004), flail chest (p = 0.018), and chest trauma score ≥ 5 (p = 0.001). Mean hospital stay in our study was 5.3 ± 3.4 days. Factors lengthening hospital stay by more than five days included lung contusion (p = 0.02), more than two rib fractures (p = 0.004), hemopneumothorax (p = 0.026), pneumonia (p = 0.003), acute respiratory distress syndrome (p = 0.003), and flail chest (p = 0.013). Conclusions Elderly patients with blunt thoracic trauma have higher mortality. Proactive evaluation of injuries using the chest trauma score in the elderly population helps in recognizing patients at high risk of mortality and helps in the timely management to prevent adverse outcomes.
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Affiliation(s)
- Nazish Sikander
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Tanveer Ahmad
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Khalil A Shaikh
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Ambreen Abid
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Misauq Mazcuri
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Shagufta Nasreen
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Clinical Analysis of the Correlation Between Rib Fractures and Prognosis in Multiple Trauma Patients. Trauma Mon 2018. [DOI: 10.5812/traumamon.58044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kiragu AW, Dunlop SJ, Mwarumba N, Gidado S, Adesina A, Mwachiro M, Gbadero DA, Slusher TM. Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions. Front Pediatr 2018; 6:155. [PMID: 29915778 PMCID: PMC5994692 DOI: 10.3389/fped.2018.00155] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/09/2018] [Indexed: 12/15/2022] Open
Abstract
Trauma constitutes a significant cause of death and disability globally. The vast majority -about 95%, of the 5.8 million deaths each year, occur in low-and-middle-income countries (LMICs) 3-6. This includes almost 1 million children. The resource-adapted introduction of trauma care protocols, regionalized care and the growth specialized centers for trauma care within each LMIC are key to improved outcomes and the lowering of trauma-related morbidity and mortality globally. Resource limitations in LMICs make it necessary to develop injury prevention strategies and optimize the use of locally available resources when injury prevention measures fail. This will lead to the achievement of the best possible outcomes for critically ill and injured children. A commitment by the governments in LMICs working alone or in collaboration with international non-governmental organizations (NGOs) to provide adequate healthcare to their citizens is also crucial to improved survival after major trauma. The increase in global conflicts also has significantly deleterious effects on children, and governments and international organizations like the United Nations have a significant role to play in reducing these. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.
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Affiliation(s)
- Andrew W. Kiragu
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
| | - Stephen J. Dunlop
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- Division of Global Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Njoki Mwarumba
- Department of Political Science, Oklahoma State University, Stillwater, OK, United States
| | - Sanusi Gidado
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Adesope Adesina
- Department of Surgery, Bowen University Teaching Hospital, Ogbomosho, Nigeria
| | | | - Daniel A. Gbadero
- Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria
| | - Tina M. Slusher
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
- Division of Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
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Kiragu AW, Dunlop SJ, Wachira BW, Saruni SI, Mwachiro M, Slusher T. Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward. J Pediatr Intensive Care 2016; 6:52-59. [PMID: 31073425 DOI: 10.1055/s-0036-1584676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/15/2016] [Indexed: 10/21/2022] Open
Abstract
Traumatic injuries are a significant cause of death and disability worldwide. The vast majority of these injuries occur in low- and middle-income countries (LMICs). Attention to protocolized care and adaptations to treatments based on availability of resources, regionalization of care, and the development of centers of excellence within each LMIC are crucial to improving outcomes and lowering trauma-related morbidity and mortality worldwide. Given limitations in the availability of the resources necessary to provide the levels of care found in high-income countries, strategies to prevent trauma and make the best use of available resources when prevention fails, and thus achieve the best possible outcomes for injured and critically ill children, are vital. Overall, a commitment on the part of governments in LMICs to the provision of adequate health care services to their populations will improve the outcomes of injured children. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.
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Affiliation(s)
- Andrew W Kiragu
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota, United States
| | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, United States.,Division of Global Medicine, University of Minnesota, Minneapolis, Minnesota, United States
| | - Benjamin W Wachira
- Accident and Emergency Department, Aga Khan University Hospital, Nairobi, Kenya
| | - Seno I Saruni
- Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | | | - Tina Slusher
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota, United States.,Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
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El-Menyar A, Abdelrahman H, Al-Hassani A, Ellabib M, Asim M, Zarour A, Al-Thani H. Clinical Presentation and Time-Based Mortality in Patients With Chest Injuries Associated With Road Traffic Accidents. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e31888. [PMID: 27148499 PMCID: PMC4853503 DOI: 10.5812/atr.31888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022]
Abstract
Background: Blunt chest trauma (BCT) poses significant morbidity and mortality worldwide. Objectives: We investigated the clinical presentation and outcome of BCT related to road traffic accidents (RTA). Patients and Methods: A retrospective observational analysis for patients who sustained BCT secondary to RTA in terms of motor vehicle crash (MVC) and pedestrian-motor vehicle accidents (PMVA) who were admitted to the trauma center at Hamad general hospital, Doha, Qatar, between 2008 and 2011. Results: Of 5118 traumatic injury cases, 1004 (20%) were found to have BCT secondary to RTA (77% MVC and 23% PMVA). The majority were males (92%), and expatriates (72%). Among MVCs, 84% reported they did not use protective devices. There was a correlation between chest abbreviated injury score (AIS) and injury severity scoring (ISS) (r = 0.35, r2 = 0.12, P < 0.001). Regardless of mechanism of injury (MOI), multivariate analysis showed that the head injury associated with chest AIS and ISS was a predictor of mortality in BCT. Overall mortality was 15%, and the highest rate was observed within the first 24 hours post-trauma. Conclusions: Blunt chest trauma from RTA represents one-fifth of the total trauma admissions in Qatar, with a high overall mortality. Pedestrians are likely to have more severe injuries and higher fatality rates than MVC victims. Specific injury prevention programs focusing on road safety should be implemented to minimize the incidence of such preventable injuries.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Corresponding author: Ayman El-Menyar, Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. Tel: +974-44394029, E-mail:
| | | | | | | | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ahmad Zarour
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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Evaluation of respiratory functions in chest trauma patients treated with thoracic wall stabilization. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kumar S, Gupta HO, Pandey A, Kumar A, Ahmad A, Kumar M, Kumar N. Thoracic trauma trends in Northern India- single center experience. Indian J Thorac Cardiovasc Surg 2013; 29:167-170. [DOI: 10.1007/s12055-013-0231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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El-Menyar A, Latifi R, AbdulRahman H, Zarour A, Tuma M, Parchani A, Peralta R, Al Thani H. Age and traumatic chest injury: a 3-year observational study. Eur J Trauma Emerg Surg 2013; 39:397-403. [DOI: 10.1007/s00068-013-0281-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/18/2013] [Indexed: 10/27/2022]
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Al-Koudmani I, Darwish B, Al-Kateb K, Taifour Y. Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases. J Cardiothorac Surg 2012; 7:35. [PMID: 22515842 PMCID: PMC3379930 DOI: 10.1186/1749-8090-7-35] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 04/19/2012] [Indexed: 12/03/2022] Open
Abstract
Background Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. Methods We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. Results The leading cause of the trauma was violence (41%) followed by traffic accidents (33%). Pneumothorax (51%), Hemothorax (38%), rib fractures (34%), and lung contusion (15%) were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%). A minority of the patients required thoracotomy (5.7%), and tube thoracostomy (56%) was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%). Conclusions New traffic laws (including seat belt enforcement) reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis.
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Affiliation(s)
- Ibrahim Al-Koudmani
- Department of Thoracic Surgery, Al-Mouassat University Hospital, Damascus, Syria.
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