Initial Treatment of Isolated Thoracic Injuries

Abstract

I ntroduction: Isolated thoracic injuries are relatively common and they are on the second place as a cause of death overall trauma. Most patients with isolated thoracic injuries are treated on an outpatient basis while only serious cases are hospitalized. The basis of the treatment of thoracic trauma is efficient cardiopulmonary reanimation followed by an early detection and treatment of life threatening injuries. Less than 15% of patients with thoracic trauma require thoracotomy. Patients: Only the patients with exclusively isolated thoracic trauma were analyzed. Results: Based on initial diagnostic procedures initial conservative treatment was indicated and sufficient for 63,75% (204/320) cases while initial surgery treatment was necessary in 36,25% (116/320) of the injured. In relation to the type of surgery the thoracic drainage was performed in 81,03% (94/116) while thoracotomy and VATS procedure was necessary for 7,75% (9/116) of the injured. After the secondary examination or shorter monitoring of the status of the injured, the additional diagnostic procedure was suggested and performed in only 5% (16/320) of the injured. The average period of the hospitalization for all injured with isolated thoracic trauma was 5,9±4,0 days (from 6 hours to 16 days). In cases of patients with blunt injuries the average period of hospitalization was 6,07±4,26 days, while for the patients with penetrating trauma it was 5,4±3,36 days. The calculated value of t-student test (0,2766 > 0,05) indicates that there is no statistically significant difference in the period of the hospitalization in relation to the type of trauma (blunt vs. penetrating). The average period of thoracic drainage was 5,58 ±3,3 days (from 3 to 17 days). The average duration of thoracic drainage in the patients with blunt trauma was 5,81±2,67 days, while in the patients with penetrating trauma it was 5,08±1,99 days. The calculated value of the probability of t -test (0,1478 > 0,05) shows that there is no significant difference in the period of drainage in cases of blunt and penetrating trauma. Out of total number of patients, 98,0% (315/320) of the injured were successfully treated. The complications were found in 1,25% (4/320) cases. Death was the outcome in 1,5% (5/320) of injured. Conclusion: Based on the results of the initial diagnostic treatment, in majority of injured with isolated thoracic trauma, it was possible to conduct the relevant and appropriate therapeutic procedures. On the basis of relatively short period of thoracic drainage, hospitalization and low rates of morbidity and mortality, it may be confirmed that the application of initial diagnostic and therapeutic protocols of the Clinic for thoracic surgery resulted in the achievement of the successful treatments in majority of the injured for this type of the trauma.

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

“…[21,22] Hemo/pneumothorax presenting with rib fractures is the most frequently seen injury. [22] The majority of these patients are treated with tube thoracostomy.…”

“…[21,22] Hemo/pneumothorax presenting with rib fractures is the most frequently seen injury. [22] The majority of these patients are treated with tube thoracostomy. [21,22] Unlike penetrating trauma injuries, fewer patients with blunt trauma injury require thoracotomy.…”

“…[21,22] Unlike penetrating trauma injuries, fewer patients with blunt trauma injury require thoracotomy. [22] In the present study, tube thoracostomy was essential and adequate in 21.9% of the patients, while 0.8% of the patients required thoracotomy. Patients with AIS >4 along with severe thoracic injuries had a higher mortality risk.…”

“…[22] The majority of these patients are treated with tube thoracostomy. [21,22] Unlike penetrating trauma injuries, fewer patients with blunt trauma injury require thoracotomy. [22] In the present study, tube thoracostomy was essential and adequate in 21.9% of the patients, while 0.8% of the patients required thoracotomy.…”

Management of Blunt Chest Injury

“…In this study, 232 (71.6%) patients had haemothorax or pneumothorax of varying amount accompanied by rib fracture, out of these 232 patients, 184 (56.8%) patients were treated by tube thoracostomy initially. In most of the series 16,17 such injuries are treated by tube thoracostomy. It is also important to keep in mind that compared with rib fractures, bilateral lung contusions associated with haemothorax or pneumothorax were a more important regarding adverse outcomes.…”