THORACIC TRAUMA

PROFILE IN TWO SEMIURBAN UNIVERSITY HOSPITALS IN NIGERIA

Abstract

Objective: To assess the pattern of thoracic trauma in two semi urban university hospitals in Nigeria, to determine the injuries associated with thoracic trauma, its management and outcome in a setting of small thoracic units and limited intensive care unit facilities. Study Design: Observational Method: The hospital records of 142 patients who sustained thoracic trauma between September 2007 and September 2010 were reviewed. The mode of injury, specific intrathoracic trauma, associated injuries, management and outcome were analyzed. Results: Eighty-two percent (82%) of patients were males and 73% of patients were above 40 years. Blunt thoracic trauma accounted for 77% of thoracic injuries. Road Traffic Accident (RTA) was the commonest cause of Blunt Chest Trauma (90%) while Gunshot injuries constituted the commonest cause of Penetrating Chest Trauma (73%). The commonest specific thoracic injuries were Rib fractures and Haemopneumothorax. Extremity injuries were the commonest associated extrathoracic injuries. Mechanical ventilatory assistance was indicated in 8.5% of patients. Only 1.4% of patients had delayed thoracotomy on account of clotted haemothorax and Empyema Thoracis. 2.8% of patients had Laparotomy for repair of Traumatic Diaphragmatic hernia. Others were managed conservatively. The mortality rate was 9.9%. Mortality was mainly among patients who required mechanical ventilatory support and those with associated severe extra thoracic injuries. Most of the patients were discharged before 20 days on admission. Conclusions: The incidence of chest trauma can be reduced by minimizing the frequency of road traffic accidents, abating violence and improving security. Most patients that sustain thoracic trauma can be managed conservatively. Mortality usually occurs in patients with associated severe extrathoracic trauma and those who require ventilatory support. Improving Intensive care unit facilities and training more trauma/thoracic surgeons and intensivists in the developing countries will help to reduce the mortality rate of chest trauma.