الفهرس | Only 14 pages are availabe for public view |
Abstract Chest traumas account for 10% to 15% of all traumas and are thecause of death in 25% of all fatalities resulting from trauma. Over 70% of thoracic injuries result from blunt trauma, most of which are caused by automobile accidents. The present study included 100 patients with acute chest trauma presented to Emergency Department of Menoufia University Hospital through prospective period from November 2014 to June 2016 to study the different presentation, management and outcome of chest trauma patients in different age populations comparing blunt and penetrating chest trauma. All patients examined according to advanced trauma life support guidelines(ATLS). Out of 100 patients, Blunt thoracic trauma was found in 72 patients, while penetrating injuries in only 28 patients. Patients suffered blunt trauma, 63 (87.5%) were males and 9 (12.5%) females. The male - female ratio was 7:1. The ages of the patients ranged between 1.5 - 70 years. The mean age was 30.7 ± 17.6 years. 73.6 % of patients were older than 18 years. On the other hand, Patients suffered penetrating trauma, 26 (92.9%) were males and 2 (7.1%) females. The male - female ratio was 13:1. The ages of the patients ranged between 13 - 60 years. The mean age was 30.1±12.8 years. 85.7 % of patients were older than 18 years. Overall, motor vehicle accident was the leading cause of blunt trauma patients (76.4%) followed by localized chest trauma (12.5%) and falling from heights (11.1%). On the other hand, Stabing was the cause of 67.9% of penetrating trauma followed by shot gun (17.8%) and gunshot (14.3%). Concerning blunt trauma, seven patients (9.7%) showed chest wall contusion, 2.8 % exhibited chest wall abrasion; Chest wall burn was found in 1.4% of patients and 6.9 % of patients suffered chest wall swelling. When comparing the type of trauma with signs found by physical examination, a highly significant difference in patients exhibiting clicks (44.4% in blunt trauma patient, 3.6% in penetrating trauma patients, P value = 0.0001) was found. A significant difference was found in patients showing crepitation (43.1% in blunt trauma patient, 20.4% in penetrating trauma patients, P value = 0.044). Also, a significant difference was found in patients exhibited diminished air entry (66.7% in blunt trauma patient, 89.3% in penetrating trauma patients, P value = 0.022). Concerning resultant pathology and type of trauma, there was significant relationship between type of trauma and multiple rib fracture and flail Chest. Twenty six patient (36.1%, p value = 0.001) and nine patients (12.5%, p value = 0.05) had multiple rib fracture and flail Chest, respectively of blunt trauma, while non was found in penetrating trauma patients. Regarding to commonly associated injuries, there was a high significant difference between blunt and penetrating trauma concerning diaphragmatic injury which was associated only with penetration trauma patients (10.7%, P value= 0.002). There was a significant difference between blunt and penetrating trauma concerning traumatic brain injury whichwas associated only with blunt trauma patients (18.1%, p value= 0.016). There was a significant relationship (p value= 0.034) between type of trauma and treatment offered. Surgical treatment was offered to 23 out of 28 patient (82.1%) with penetrating trauma and 43 out of 72 patients (59.7%) with blunt trauma, while conservative treatment was offered to 5 out of 28 patient (17.9%) with penetrating trauma and 29 out of 72 patients (40.3%) with blunt trauma. Mechanically ventilated patients in our study were 65 patients (90.3%) in blunt trauma and 25 patients (89.3%) in penetrating trauma with no significant difference. Various surgical treatments were offered for the studied groups. Blunt trauma patients went for lung repair, Intercostal tube (ICT) insertion, wire surgical fixation, lobectomy, pleural decortication, thoracoscope and F.B removal by local anesthesia (2.8, 55.6, 5.6, 1.4, 4.2, 1.4 and 1.4 % respectively).Penetrating trauma patients went for lung repair, ICT insertion, cardiac repair, diaphragmatic repair and pleural decortication, (3.6, 82.1, 3.6, 7.1 and 3.6 % respectively). There was significant difference in application for ICT insertion between blunt and penetrating trauma patients (p value= 0.013). ICT insertion was performed in 82.1 %with penetrating trauma compared to 55.6% with blunt trauma.Significant difference was found between blunt and penetrating trauma patients (p value = 0.016) regarding ward admission. All studied group with penetrating trauma admitted in the cardiothoracic ward compared to 81.9% for blunt trauma patients with non-significance difference in ward stay days. Also, Significant difference was found between blunt and penetrating trauma patients those were ICU admitted (p value = 0.013). Only 17.9% of penetrating trauma patients admitted in ICU compared to 44.4% of blunt trauma patients with high significance difference in ICU stay days (p value = 0.009) since blunt trauma patients stayed for 2.74±5.59 days compared to 0.36±0.91 recorded for penetrating trauma patients. In fact, No mortalities were recorded in penetrating trauma patients since all patients were discharged after treatment and improvement. Regarding blunt trauma patients,6.9% died, 81.9% discharged after treatment and improvement and 11.1% not admitted as no lesions found by investigation and follow up. |