medico legal study on cases of blunt chest injuries referred to menoufiya University Hospital in one year [2000-2001]

ABSTRACT

Chest trauma is one of the most common injuries either as isolated injuries or in polytraumatic patients. The study was carried out on all patients received or referred to Menoufiya University Hospitals [MUH] with blunt chest injuries during the period of the study in order to study the magnitude of the problem from it's different medico-legal aspects. A clinical sheet was filled for each injured case including all personal data, the clinical examination, radiological investigations and the follow up of the cases till their discharge. 200 injured patients with different chest trauma were examined by Forensic Med. and Clinical Toxicology Department from the first of June 2000 to the end of May 2001 [study period], and 163 cases of them were blunt chest trauma. They were 104 males and 59 females with a sex ratio [1.81]. 1] The maximum number of the injured male patients was encountered in the age group 15->25 years old and in females it was in age group 35<45 years old. The least number of the cases was in the age group <5 years among both sexes. As regard the marital status singles [56.4%] outnumbered married ones. The study revealed that nearly half of the cases [49.1%] were illiterate and mostly manual workers. More than half of the cases [58%] were transported by ambulance and the arrival of the cases to the hospital was mainly in the morning shift. Chest injuries were more common in rural areas [62.6%], than in urban areas and 75% of injuries were due to assaults and the rest of the cases were accidental injuries, most of them were due to motor vehicle accidents. As regard the site of injuries, the commonest site was the front of the chest [59%] and [41%] of injuries were present in the back. Contusions were the most common type of lesions [60%] followed by abrasions [33%] and lastly contused wound [7%]. Associated chest and other regional body injuries were more common than isolated chest injuries [74% - 26%] respectively. The most common combinations were blunt injuries in different regions of the body [the upper limbs 35%, head injuries 22% followed by abdominal injuries 10% and lastly with lower limbs 7%]. X-ray was done in about 29% of the cases and it was free in more than half of them. Isolated rib fracture [14%], rib fractures with pleural injuries [3.5%], pleural injuries without rib fractures in the form of haemothorax, pneumothorax, and haemo-pneumothorax [21%], and isolated clavicle fractures [8.5%] were the main radiological findings. The study revealed that 69% of the injured patients were managed in the emergency room as outpatient and discharged immediately. The remaining cases [31%] were admitted and discharged later on. The mortality rate was 6% most of them were in a very bad condition at the time of arrival. Recommendations: to minimize the complications and mortalities of chest injuries the following is advised Well equipped ambulances for rapid and save transportation with well trained ambulance and emergency personnel should always be available. Also more strict law enforcement with severe penalty is suggested for disobeying speed limits and traffic safety rules. The risky injured cases should be referred to the highly equipped hospitals,. Also more educational programs indicating the correct dealing with the cases of chest trauma should be done