Chest Injuries in Polytrauma

Abstract Background and Purpose: Blunt chest injuries are commonly seen in polytrauma patients and are known to be associated with higher mortality and morbidity. The objectives of the present study are to assess the effect of blunt chest injury concerning morbidity, mortality as well as clinical courses and outcome of multiply injured patients with chest trauma. Patients and Methods: This study includes all polytrauma patients with chest injury treated between 1992 and 2002 at a major urban trauma center. Parameters examined included injury pattern, injury severity, mortality, hemodynamics at admission, duration of ventilation, length of stay in intensive care unit (ICU), and outcome. Results: 332 out of 501 polytrauma patients, 228 males and 104 females, had a coexisting chest injury. Mean age at the time of injury was 37.7 years, and 258 patients were intubated before admission. Average period on ICU was 15.4 days, and 35.9 days for total hospital stay. Regarding the injury pattern in 143 patients a combined hemo-/pneumothorax was seen, 109 patients had either a hemothorax or a pneumothorax, in 155 patients a unilateral and in 52 patients a bilateral serial rib fracture was diagnosed, in 28 patients either sternal or singular rib fractures were determined, in a total of 23 patients an unstable thorax or a flail chest was seen, 105 patients had a unilateral pulmonary contusion, and in 79 patients a bilateral pulmonary contusion was diagnosed. Finally, a total of eleven patients with a traumatic aortic disruption were identified. Conclusion: The present study shows that chest injuries in polytrauma patients are common coexisting injuries and contribute significantly to the morbidity and outcome of these patients. Early intubation and ventilation in combination with an adequate circulatory stabilization are crucial to avoid complications and deleterious outcome.