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 Abstract
Objective
To identify common causes of adult chest
injuries among patients admitted to King
Hussein Medical Center (KHMC) in Jordan
and to review methods of prevention.
Materials and Methods
A retrospective analysis of ninety cases of
chest trauma above the age of 17 years,
for a period of 30 months, from January
1999 to June 2001 admitted to KHMC.
Analysis included their age, sex,
associated medical illnesses, history of
smoking, causes of injuries, chest
injuries, associated other organs
injuries, days of hospital stay,
management, mortality and morbidity.
Results
The total numbers of patients were ninety, their
mean age was 34.1 years ranging from
(17-70) years.
77(85.6%) were adult males and
13(14.4%) were females.
Road traffic accidents were the
most common cause of injuries in 69
(76.6%), followed by firearm injuries in
16 (17.2%), iatrogenic due to central
venous cannulation in 5(5.6). Their
mean hospital stay was 11.1 days.
The mortality rate was 8 (8.8%).
Conclusion
Road traffic accidents, firearm injuries, and
iatrogenic central venous cannulation were
the most common causes of chest injuries
in adults in this study. Methods of
prevention are reviewed.
Introduction
In this study we focused on the causes of
adult chest injuries admitted to KHMC
during a 30 month period and it was
noticed that the three common causes were,
road traffic accidents, firearm injuries
and iatrogenic central venous cannulations.
As chest injuries are the most common
cause of death among people 1-34 years of age,
leading cause of disability and years of
life lost, and a major contributor to
health care costs. This study
highlights these problems from many
aspects and reviews what could be
practical strategies to reduce or prevent
these injuries with the hope of increasing
their dissemination and encouraging the
participation of the medical community in
injury control.
Patients and Methods
King Hussein Medical Center is an 823 bed
hospital in the Capital of Jordan - Amman,
and the chest surgery section is a
referral section for treatment of chest
trauma and other surgical chest
diseases. Retrospective analysis of
ninety cases of isolated and associated
chest injuries admitted to our Center from
January 1999 to June 2001 were included in
this study.
Evaluation of causes of chest injuries in adults over 17 years was
highlighted besides assessing other
associated injuries and their management.
Morbidity and mortality were
analyzed.
Results
Among the ninety adult patients admitted to KHMC
during 30 month period from January 1999
to June 2001, 77 patients were males
(85.6%) and 13 patients were females
(14.4%) their mean age was 34.1 years
ranging from (17-75) years. 69 patients
sustained blunt trauma due to car
accidents (76.7%), of them 59 patients
were inside the cars and 10 patients were
pedestrians. 16 patients sustained
penetrating firearm injury (17.2%), of
them 10 as bullet injuries, 4 as gunshot
injuries and 2 as stab wound injuries. 5 patients (5.6%) sustained chest injury due to iatrogenic
central venous cannulation as most
patients are young only 13 patients
(14.4%) had associated medical illnesses
such as hypertension, IHD, diabetes, chronic renal failure. 43 patients were smokers (47.3%)
and 47 patients
non-smokers (52.3%).
The total hospital days for all patients were
1000 hospital days with the average of
11.1 days.
In chest trauma, 21 patients (23.3%) had simple rib fracture without
complications, 5 patients (5.6%) had
associated sternal fractures, 12 patients
(13.3%) had flail chest, 52 patients
(57.7%) had associated hemo-pneumothorax
either unilateral or bilateral and 36
patients (40%) had lung contusions either
unilateral or bilateral. 48 patients
(53.5%) had other organ injuries including
limb fractures, head injuries,
diaphragmatic, abdominal organ injuries,
burns, and soft tissue injuries. Table 1.
Chest injuries management
TABLE 1: OTHER
ORGANS INJURED
consisted
of non-steroidal anti-inflammatory
injections, O2 mask, respiratory therapy
for 30 patients (33.3%), 19 patients
(21.1%) needed ventilator assistance for
variable days including those with flail
chest and severe lung contusions or head
injury, the remaining patient with
hemo-pneumothorax needed chest tube
drainage unilateral or bilateral.
9 patients (11%) developed other
complications like bedsores, Tracheal
stricture, perforated duodenal ulcer,
colitis, and keloid formation and were
treated accordingly. Table 2 shows
types of complications, and their
management. 8 patients (8.8%) died
due to respiratory failure, head injury,
peritonitis, myocardial infarction,
multiorgan failure as seen in table 3.
TABLE
2: MORBIDITY, NUMBERS OF PATIENTS,
MEASURES TAKEN
TABLE
3: CAUSES OF DEATHS
Discussion
In the first hour after hospital admission thoracic, vascular and
neurological trauma are most common causes
of death, Overall thoracic trauma has a
mortality rate of 10%(1), which is 8.8% in
our study.
Formal operative treatment was
needed in 10% of blunt trauma and 15% -
30% of penetrating injuries (2-5).
In this study 10 of 69 patients with blunt
trauma underwent operative procedures that
is 14.4%, and 4 of 16 patients with
penetrating trauma underwent operative
intervention that is 25%. Injuries
from motor vehicle involvement are the
third leading cause of years of potential
life lost (615.5 years per 100,000
population) under the age of 65 years in the United States (6), and crashes are estimated to result in over
523,000 hospitalizations in the United
States each year (7). About 41% of
fatal injuries and 9% of non-fatal
injuries from motor vehicle crashes are
associated with the use of alcohol
(8). Intoxicated drivers have an
increased risk of injury because their
driving skills are impaired (9) and they
are less likely to use seat belts and more
likely to speed than sober drivers (10).
In our study none of the motor vehicle
crashes was associated with the use of
alcohol thank God, who prohibits the use
of alcohol in our Muslim community, which
prevents a lot of diseases and crashes
related to alcohol use.
The use of vehicles which have
safety standards can reduce the risk of
death like the energy-absorbing steering
columns, increased padding on the interior
contact points, and enhanced side impact
protection. The current three-point,
lap-shoulder restraints are thought
to reduce the risk of death and serious
injury by 45% (11,12), and car seats for
children reduce the risks by approximately
70% (13).
A recent prospective cohort study
estimated that seat belts or air bags
reduced the risk of severe injury by 61%
and reduce the risk of hospitalization by
33% in the event of crash (14).
Physicians can help prevent injuries in
occupants of motor vehicles by promoting
the proper use of seat belts and safety
seats for children (15).
Injuries to pedestrians are the
second largest category of motor vehicle
deaths in this article. The number
of pedestrians was 10 out of 69 patients
involved in road traffic accidents.
Children particularly school-aged children
are at greatest risk(16). The risk factors
for children include an age of 5-9 years
(16), male (16), poverty (17-20),
household crowding (17,21), inadequate
parental supervision (18), and family
stress (22). Our study didn't
include child age but this can highlight
the risks which can be prevented by
improving all the risk factors mentioned
and reducing the amount of unsupervised
walking children do. (23) Other
countries have approached the problem of
injuries to pedestrians almost entirely
through environmental modification known
as traffic calming (24) by diverting high
volume, high speed traffic away from the
core of the city and residential areas,
slowing city traffic to 16-32 km/hour and
narrowing the streets. These changes
reduce the risk of injury for pedestrians
of all ages, but especially children and
the elderly (24). Regarding
cyclists. the use of helmets are very
effective in preventing head and brain
injuries by 85% and 88% respectively (25)
and preventing some injuries to the face
(26).
Helmet use can be increased by a
combination of legislative (27) and
educational (28) approaches as well as
counseling by physicians. The use of
separate lanes for bicycles may help but
their effectiveness has not been
evaluated.
Injuries from firearms has
increased since in 1985; the number of
homicides, especially among people 15-24
years of age has increased (29) from 67% - 87% and from 60-72% for all
ages (29).
Firearms account for 60% of all
suicides (even higher in elderly men(30)).
Putting greater stress an enforcing
legislation barring young people from
carrying guns (31). Legislation
reducing access to guns was associated
with 25% reduction in homicides in
Washington D.C (32) and
36% reduction in the suicide rate
in Queens land, Australia. (33).
Central venous cannulation seems to be
increased in number in
recent years because it is
essential for monitoring intensive care
and coronary care patients, as well as for
chemotherapy and total parentral nutrition
and other uses. Subclavian
venipuncture is often a successful and
uncomplicated procedure. Reported
complication rates range from 0.3-12%,
according to the experience of the
physician and the definition of
complication(34). Prevention of
these injuries is by taking proper steps
and insertion to be done by experienced
surgeons or anesthetist, some times under
fluoroscopy guidance or open surgical
techniques. In conclusion, we see
that road traffic accidents, firearm
injuries and iatrogenic central venous
cannulation were the most common causes of
chest injuries in adults in this
study. Educating the public
on how to use safety methods in
dealing with these issues will
significantly reduce the number of injured
patients and reduce the cost and all other
loses from injury.
References
Other
Topics:
Original Study #
1 -
The Four Hour Accident & Emergency Wait
Can it be achieved in the UK?
Original Study #
3 - Management of Non-Penetrating
Traumatic Hyphema in Ophthalmology
Department of HMC Review of 83 cases
Original Study #
4 - Visual Impairment and Motor Vehicle
Accidents
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