الفهرس 
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Abstract
Chest traumas account for 10% to 15% of all traumas and are
thecause of death in 25% of all fatalities resulting from trauma. Over
70% of thoracic injuries result from blunt trauma, most of which are
caused by automobile accidents.
The present study included 100 patients with acute chest
trauma presented to Emergency Department of Menoufia University
Hospital through prospective period from November 2014 to June
2016 to study the different presentation, management and outcome of
chest trauma patients in different age populations comparing blunt
and penetrating chest trauma.
All patients examined according to advanced trauma life
support guidelines(ATLS). Out of 100 patients, Blunt thoracic trauma
was found in 72 patients, while penetrating injuries in only 28
patients. Patients suffered blunt trauma, 63 (87.5%) were males and 9
(12.5%) females. The male - female ratio was 7:1. The ages of the
patients ranged between 1.5 - 70 years. The mean age was 30.7 ±
17.6 years. 73.6 % of patients were older than 18 years. On the other
hand, Patients suffered penetrating trauma, 26 (92.9%) were males
and 2 (7.1%) females. The male - female ratio was 13:1. The ages of
the patients ranged between 13 - 60 years. The mean age was
30.1±12.8 years. 85.7 % of patients were older than 18 years.
Overall, motor vehicle accident was the leading cause of blunt
trauma patients (76.4%) followed by localized chest trauma (12.5%)
and falling from heights (11.1%). On the other hand, Stabing was the
cause of 67.9% of penetrating trauma followed by shot gun (17.8%)
and gunshot (14.3%).
Concerning blunt trauma, seven patients (9.7%) showed chest
wall contusion, 2.8 % exhibited chest wall abrasion; Chest wall burn
was found in 1.4% of patients and 6.9 % of patients suffered chest
wall swelling. When comparing the type of trauma with signs found
by physical examination, a highly significant difference in patients
exhibiting clicks (44.4% in blunt trauma patient, 3.6% in penetrating
trauma patients, P value = 0.0001) was found. A significant
difference was found in patients showing crepitation (43.1% in blunt
trauma patient, 20.4% in penetrating trauma patients, P value =
0.044). Also, a significant difference was found in patients exhibited
diminished air entry (66.7% in blunt trauma patient, 89.3% in
penetrating trauma patients, P value = 0.022).
Concerning resultant pathology and type of trauma, there was
significant relationship between type of trauma and multiple rib
fracture and flail Chest. Twenty six patient (36.1%, p value = 0.001)
and nine patients (12.5%, p value = 0.05) had multiple rib fracture
and flail Chest, respectively of blunt trauma, while non was found in
penetrating trauma patients.
Regarding to commonly associated injuries, there was a high
significant difference between blunt and penetrating trauma
concerning diaphragmatic injury which was associated only with
penetration trauma patients (10.7%, P value= 0.002). There was a
significant difference between blunt and penetrating trauma
concerning traumatic brain injury whichwas associated only with
blunt trauma patients (18.1%, p value= 0.016).
There was a significant relationship (p value= 0.034) between
type of trauma and treatment offered. Surgical treatment was offered
to 23 out of 28 patient (82.1%) with penetrating trauma and 43 out of 72 patients (59.7%) with blunt trauma, while conservative treatment
was offered to 5 out of 28 patient (17.9%) with penetrating trauma
and 29 out of 72 patients (40.3%) with blunt trauma. Mechanically
ventilated patients in our study were 65 patients (90.3%) in blunt
trauma and 25 patients (89.3%) in penetrating trauma with no
significant difference.
Various surgical treatments were offered for the studied
groups. Blunt trauma patients went for lung repair, Intercostal tube
(ICT) insertion, wire surgical fixation, lobectomy, pleural
decortication, thoracoscope and F.B removal by local anesthesia (2.8,
55.6, 5.6, 1.4, 4.2, 1.4 and 1.4 % respectively).Penetrating trauma
patients went for lung repair, ICT insertion, cardiac repair,
diaphragmatic repair and pleural decortication, (3.6, 82.1, 3.6, 7.1 and
3.6 % respectively). There was significant difference in application
for ICT insertion between blunt and penetrating trauma patients (p
value= 0.013). ICT insertion was performed in 82.1 %with
penetrating trauma compared to 55.6% with blunt trauma.Significant
difference was found between blunt and penetrating trauma patients
(p value = 0.016) regarding ward admission.
All studied group with penetrating trauma admitted in the
cardiothoracic ward compared to 81.9% for blunt trauma patients
with non-significance difference in ward stay days. Also,
Significant difference was found between blunt and penetrating
trauma patients those were ICU admitted (p value = 0.013). Only
17.9% of penetrating trauma patients admitted in ICU compared to
44.4% of blunt trauma patients with high significance difference in
ICU stay days (p value = 0.009) since blunt trauma patients stayed for 2.74±5.59 days compared to 0.36±0.91 recorded for penetrating
trauma patients. In fact,
No mortalities were recorded in penetrating trauma patients
since all patients were discharged after treatment and improvement.
Regarding blunt trauma patients,6.9% died, 81.9% discharged after
treatment and improvement and 11.1% not admitted as no lesions
found by investigation and follow up.