Thoracic trauma in national hospital Abuja, Nigeria: The epidemiology, injury severity and initial management options

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.

Pre-hospital intercostal chest drains in South Africa: A modified Delphi study

Introduction :Trauma is one of the most common causes of death in low- and middle-income countries, with thoracic injury accounting for 20­25% of these deaths worldwide. The current management of a life-threatening pre-hospital pneumothorax is with a needle chest decompression, however, definitive care for a pneumothorax and/or haemothorax is still the insertion of an intercostal chest drain. The aim of this study was to seek expert opinion and consensus on the placement of ICDs in the pre-hospital emergency care setting in South Africa. Methods:A three-round modified Delphi study was undertaken with an expert panel drawn from local emergency care experts consisting of physicians and emergency medical service practitioners. Participants supplied opinion statements in round 1 under headings derived from common emerging themes found in the literature. During round 2 participants used a 9-point Likert scale to rate their consensus on each statement and in round 3 they were able to change their position based on the earlier panel distributions. A consensus percentage of 60% was set within a narrow margin of 'strongly agree' or 'strongly disagree'.Results : A total of 22 experts took part as panel members. There were 123 opinion statements produced from round 1, of which 21 (17%) reached consensus in round 2. At the end of round 3 another four statements reached consensus, bringing the total up to 25 (20%).Conclusio:Definitive care of a life-threating pneumothorax and/or haemothorax must be sought emergently.The insertion of an ICD, under select conditions, may be required in the pre-hospital setting in South Africa

Pattern of chest injuries and treatment outcome in a nigerian teaching hospital

Chest injuries are a common type of injuries associated with significant morbidity and mortality. Its occurrence in all parts of the world with high impact on the productive age groups makes it important research area. To evaluate the pattern of chest injury with outcome of treatment in our centre. Retrospective review of patients' data and clinical information from January 2014 to December 2016 in the Surgical Out Patient Department of University of Uyo Teaching Hospital, Uyo, Nigeria. Over the three year period, 442 patients with diagnoses of chest injuries were included with age range 2years to 78years (mean=38.7years) and male: female ratio of 3.5:1. Students, civil servants and motorcyclists/tricyclists operators and drivers were commonly affected (27.6%, 25.1%, 26.9% and 9.3%). Blunt chest injury was commoner than penetrating chest injury (69.7% vs 30.1%); while motor vehicular accident accounted for the majority of chest injury (55.% %) followed by assault (23.1%). Rib fracture was the commonest type of injury (85.5%) followed by haemothorax 29.3%, haemopeumothorax 25.6% and pneumothorax 9.5%. Associated injuries included fracture of upper and lower limb (3.4%), abdominal injury (3.4%) and head injury (2.8%). Majority (89.1%) of the patients were managed either conservatively or with tube thoracostomy with good outcome (96.4%) and mortality rate of 1.1%. Many clinical entities of chest injuries were treated with a low mortality figure of 1.1%

The Pattern and Management of Chest Trauma at Muhimbili National Hospital; Dar es Salaam

Background: Chest trauma is common and its pattern varies in different places. Majority of patients are managed mainly conservatively. Tube thoracostomy is a simple procedure but it is associated with significant number of complications. The aim of this study was to evaluate the clinical pattern and its management at Muhimbili National Hospital. Methods: A hospital based prospective study of all consecutive patients admitted with chest trauma at Muhimbili National Hospital between November 2007 and September 2008. Clinical assessment and chest x-ray findings were used to diagnose and to evaluate any complications associated with chest tubes using a structured questionnaire. Results: The majority (95/119) of patients were males. Their age ranged from 12 to 72 years with the mode of 32 years. Motor traffic injury (MTI) was the commonest cause of chest trauma accounting for 72.3of the cases. Rib fractures were the most clinical type of chest injury and accounted for about 42.9of cases. Blunt chest injuries were more common (75.6) than penetrating injuries. Seventy three (61.3) patients had other associated injuries; in which fracture of extremities (25.2) and head injury (21.8) were the commonest. Sixty seven (56.3) patients were treated with closed tube thoracostomy only. The overall complication rate of the chest tubes was 32.9of which infection (24.7) and nonfunctional tubes (17.4) were the commonest. High mortality rate of 24.2was recorded. Conclusion: The clinical pattern and the management of chest injuries in this study was similar with many other series of study; however; the rate of closed tube thoracostomy remained high with many and avoidable complications

Rupture diaphragmatique gauche dans le service de chirurgie A de l'hôpital national du Point G: étude de deux cas

A l'occasion de 2 observations de rupture diaphragmatique gauche avec éviscération de plusieurs viscères abdominaux dans le thorax; nous nous proposons de rappeler quelques points importants du diagnostic et traitement de ces lésions traumatiques rares du diaphragme. En 31 mois (janvier 1993 - juillet 1995) nous avons recense dans notre service 2 cas de rupture diaphragmatique gauche. Il s'agit de 2 hommes; le premier a 38 ans et le second a 20 ans; tous victimes d'un accident de la circulation. Le premier a été reçu en urgence dans le cadre de polytraumatisme; le second a froid 2 mois après son accident pour des manifestations cliniques thoraco-abdominales gauches. Le traitement chirurgical a consisté après la réduction de l'éviscération à faire un parage et une suture des piliers et des legs du diaphragme; ainsi qu'un mécanisme anti reflux selon Nissen. Les suites opératoires ont été simples dans l'ensemble les ruptures diaphragmatiques sont rares et ne rencontrent que dans 1 a 2 pour cent des traumatismes thoraciques fermes graves. Elles peuvent également se voir dans les traumatismes ou prédomine un impact abdominal. Les lésions gauches sont habituellement plus fréquentes. Le diagnostic de rupture diaphragmatique gauche est souvent difficile et pour plusieurs raisons: la lésion se situe habituellement dans un contexte de polytraumatisme qui peut la masquer; la symptomatologie est parfois retardée de plusieurs heures ou jours; enfin certaines ruptures restent muettes pendant des mois voire des années et ne manifestent que tardivement par une complication de l'éviscération viscérale abdominale dans le thorax. Nos résultats sont comparables à ceux des auteurs africains et européens

Aspects epidemiologiques et cliniques des traumatismes du thorax dans les services des urgences chirurgicales et de traumatologie de l'HGT a propos de 125 cas

Les traumatismes thoraciques se definissent comme des lesions traumatiques interessant la paroi et /ou le contenu visceral du thorax. Il se divise en deux grands groupes a savoir les traumatismes fermes et les plaies du thorax. Le but de notre travail etait de decrire les aspects epidemiologiques ; determiner les aspects anatomo-pathologiques; cliniques et evolutifs et de decrire les elements de prise en charge des traumatismes du thorax a l'hopital Gabriel Toure. Il s'agissait d'une etude prospective qui s' est deroulee dans les services des urgences chirurgicales; de chirurgie orthopedique et traumatologique de l'HGT de Bamako sur une periode de 12 mois allant du 1er Janvier 2003 au 31 decembre 2003 et a porte sur 125 patients presentant un traumatisme thoracique; qu'il soit isole ou associe dans le cadre d'un polytraumatisme. Les adultes jeunes ont ete les plus touches de meme que le sexe masculin avec un sexe ratio de 3;46 en faveur des hommes. La frequence la plus elevee a ete enregistree au mois d'aout. L 'etiologie reste dominee par les AVP; les fractures pluricostales constituent le type de lesions parietales le plus frequent . l'hemopneumothorax a ete l'atteinte pleurale la plus frequente. Les lesions viscerales sont de diagnostiques difficiles; necessitant souvent des moyens lourds. Le associations lesionnelles sont tres frequentes dominees par les traumatismes cra- niens. Le drainage thoracique lorsqu'il est bien utilise reste la principale arme therapeutique. 11;2des cas seulement ont beneficie d'un transport medicalise d'ou la necessite de structures specialisees pour le ramassage rapide et la prise en charge prehospitaliere des traumatises