A pathology not be overlooked in blunt chest trauma: Analysis of 181 patients with bilateral pneumothorax

Abstract

BACKGROUND: Bilateral pneumothorax (BPTx) can become tension PTx and a cause of mortality, especially in severe multi-trauma patients. The purpose of this study was to analyze the incidence, morbidity, mortality, and associated factors of BPTx in multi-trauma patients in order to highlight the importance of the management of these cases, as well as complications, morbidity, and mortality. METHODS: The data of 181 patients with BPTx, from a total of 3782 trauma patients, were reviewed retrospectively. The details recorded were age, gender, mechanism of trauma, radiological findings, co-existing thoracic and extra-thoracic injuries, incidence of intubation, mortality, and injury severity score (ISS). The association between laterality of rib fracture, hemothorax, subcutaneous emphysema, and BPTx, and the effect of age and gender on these injuries, mortality, and ISS were analyzed. RESULTS: The patient group included 144 males, and the mean age was 36.07±15.77 years. The primary cause of trauma was a motor vehicle accident, seen in 67 (37.0%) patients. Bilateral rib fractures were detected in 75 (41.4%) patients. Hemothorax accompanied PTx in 41 (22.6%) patients bilaterally. The laterality of the rib fracture and hemothorax demonstrated a significant difference in the patient group over 60 years of age (p=0.017, p=0.005). Co-existing bilateral thoracic injuries were detected more often in this group. Twelve (17.6%) patients with only blunt chest trauma and 56 (82.4%) patients with multi-trauma were intubated. The difference between the 2 groups was not significant (p=0.532). The overall mortality rate was 18.2%. A comparison of ISS and mortality between the groups revealed no significant difference (p=0.22). CONCLUSION: The incidence of BPTx after multi-trauma is approximately 5%, so it must be taken into consideration, especially in severe multi-trauma patients, to reduce mortality. Older age and the number of rib fractures were determined to be risk factors for morbidity and mortality in trauma with BPTx.

Bilateral thoracic trauma; presentation and management, a case series

“…The most prevalent mechanism of thoracic trauma in this study was RTA, accounting for more than half of the total cases (63.6%) and 94% of the blunt chest trauma, this is in accordance with the international standard for the unilateral chest trauma [ 11 , [13] , [14] , [15] , [16] ]. Rib fracture is a frequent manifestation of blunt chest trauma.…”

“…According to most of the reports, blunt thoracic trauma occurs more prevailingly and has a higher mortality rate than penetrating thoracic trauma. Penetrating thoracic trauma generally forms only one-third of the chest trauma patients [ 11 ]. In this regard, bilateral chest trauma may have the same picture as in the current study, two-third of the patients had blunt thoracic trauma and it is significantly associated with a higher risk of mortality (P-value 0.014).…”

“…Endotracheal intubation is an imminent strategy when an airway is about to collapse. However, intubation and subsequent ICU admission are well-recognized to be the two predictors of mortality in chest trauma [ 11 , 14 ]. This correlation was confirmed by the current study (both P-values were <0.001).…”

Evaluation of Rib Fractures due to Trauma

“…Blunt thoracic trauma is an important cause of mortality and morbidity in developing countries. Blunt thoracic trauma accounts for approximately 75% of chest trauma [17]. Rib fractures usually cause pneumothorax and hemothorax, and its incidence has been reported to be 35% [17].…”

“…Blunt thoracic trauma accounts for approximately 75% of chest trauma [17]. Rib fractures usually cause pneumothorax and hemothorax, and its incidence has been reported to be 35% [17]. Traffic accidents, which are the main cause of rib fractures, have been reported with a rate of 47.5% to 70.9% in different studies [17].…”