Management and Immediate Outcome of Chest Injuries among Trauma Patients Admitted At Muhimbili National Hospital

Abstract

Background: Chest injuries prevails about 1/5 th of all trauma patients. The magnitude varies from different parts of the world because of differences in infrastructure, social economic activities, wars and crimes. Fortunately enough, majority of chest injuries can be managed by nonsurgical methods .Complications in chest trauma develop as a result of pain and inadequate ventilation. Objective: This study aimed at determining the prevalence, associated factors, management and immediate outcome of chest injuries among trauma patients admitted at Muhimbili National hospital. Methodology: Prospective analysis of 282 trauma patients who were admitted at Muhimbili hospital from September 2019-february 2020. Systematic random technique was used to enrol trauma patients in this study. Data were collected using a pretested structured questionnaire and a check list, and were analysed using SPSS version 23. Statistical association between mortality of chest injury patients and management pattern, and various associated prognostic factors was done using cross tabulations and Chi-square test was used to compare proportions, p value <0.05 was considered to be statistically significant. Multivariate analysis was done to examine the influence of the selected (associated) independent variables to the outcome variable. Results: This study involved 282 trauma patients who were admitted at MNH. The median age was 30 years with age range of 1-82. Many patients with chest injuries were in the age group 20-39 years. The prevalence of chest injury among trauma patients was 18.1 %. The majority 17 (33.3%), presented with lung contusion, followed by pneumothorax 8(15,7%) and rib fracture 8(15,7). Road traffic accident (80.4%) was the leading mode of injury. Associated injuries were noted in 44(86.3%) of patients and head/neck 34(66.7%) were commonest affected. All patients (100%) were treated successfully with non-operative approach. Majorities (52.9%) of the patients were managed by tube thoracostomy and (42.1%) were managed conservatively. Most of the patients were provided with more than one type of pain medication 28(55%), while 23(45%) were provided with one type of pain medication. 12(23.5 %) patients necessitated invasive ventilation while,16(31.4%) required noninvasive ventilation and 23(45.1 %) did not require any assisted ventilation. There was a statistically significant association between pain management and ventilation. Mortality rate was 21.6%. Using multivariate logistic regression analysis, associated injuries, ISS >25, delayed presentation to hospital and invasive ventilation were found to be significant predictors of mortality. Conclusion: Chest injuries prevails significantly among trauma patients. Adequate pain management, multimodal pain approach, assisted ventilation are determinants of quick recovery and avoidance of complications. Early use of NIV in appropriately identified patients with chest injuries and without respiratory distress may prevent intubation and mortality. Associated injuries, ISS, severity of chest trauma and shorter duration of injury and presentation to hospital significantly determine mortality.