Department of Thoracic Surgery and Thoracic Endoscopy,
Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen
, Essen
, Germany
This comprehensive review aims to delineate the prevailing non-cardiac thoracic injuries occurring in urban environments following initial on-site treatment and subsequent admission to hospital emergency departments. Our study involved a rigorous search within the PubMed database, employing key phrases and their combinations, including "thoracic injury," "thoracic trauma," "haemothorax," "lung contusion," "traumatic pneumothorax," "rib fractures," and "flail chest." We focused on original research articles and reviews. Non-cardiac thoracic injuries exhibit a high prevalence, often affecting poly-trauma patients, and contributing to up to 35% of polytrauma-related fatalities. Furthermore, severe thoracic injuries can result in a substantial 5% mortality rate. This review provides insights into clinical entities such as lung contusion, traumatic haemothorax, pneumothorax, rib fractures, and sternal fractures. Thoracic injuries represent a frequent and significant clinical concern for emergency department physicians and thoracic surgeons, warranting thorough understanding and timely intervention.
Petrone P, Asensio J. Surgical management of penetrating pulmonary injuries. Scand J Trauma Resusc Emerg Med. 2009;(1):8.
2.
Apostolakis E, Apostolaki G, Apostolaki M, Chorti M. The reported thoracic injuries in Homer’s Iliad. J Cardiothorac Surg. 2010;(1):114.
3.
Veysi V, Nikolaou V, Paliobeis C, Efstathopoulos N, Giannoudis P. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop. 2009;(5):1425–33.
4.
Mahmood I, El-Menyar A, Younis B, Ahmed K, Nabir S, Ahmed M. Clinical Significance and Prognostic Implications of Quantifying Pulmonary Contusion Volume in Patients with Blunt Chest Trauma. Med Sci Monit. 2017;3641–8.
5.
O’connor J, Adamski J. The Diagnosis and Treatment of Non-Cardiac Thoracic Trauma. J R Army Corps. 2010;(1):5–14.
6.
Okugbo S, Okoro E, Irhibogbe P. Chest trauma in a regional tRAUMA centRE. J West Afr Coll Surg. 2012;(2):91–101.
7.
Afshar A, Mangeli M, Nakhaei F, A. Evaluation of Injuries Caused by Penetrating Chest Traumas in Patients Referred to the Emergency Room. Indian J Surg. 2015;(3):191–4.
8.
Legare C, Sawatzky JA. Dyspnea in the Thoracic Trauma Patient: A Human Response to Illness. J Trauma Nurs. 2010;(1):36–42.
9.
Karcz M. Noninvasive ventilation in trauma. World J Crit Care Med. 2015;(1):47.
10.
The A, Subcommittee. American College of Surgeons’ Committee on Trauma, and the International ATLS working group. J Trauma Acute Care Surg. 2013;(5):1363–6.
11.
Ludwig C, Koryllos A. Management of chest trauma. J Thorac Dis. 2017;(S3):172–7.
12.
Aukema T. Initial assessment of chest X-ray in thoracic trauma patients: Awareness of specific injuries. World J Radiol. 2012;(2):48.
13.
Agladioglu K, Serinken M, Dal O, Beydilli H, Eken C, Karcioglu O. Chest X-rays in detecting injuries caused by blunt trauma. World J Emerg Med. 2016;(1):55.
14.
Lang P, Kulla M, Kerwagen F, Lefering R, Friemert B, Palm HG. The role of wholebody computed tomography in the diagnosis of thoracic injuries in severely injured patients -a retrospective multi-centre study based on the trauma registry of the German trauma society (TraumaRegister DGU®). Scand J Trauma Resusc Emerg Med. 2017;(1):82.
15.
Williamson J, Grainge C, Parameswaran A, Twaddell S. Thoracic Ultrasound: What Nonradiologists Need to Know. Curr Pulmonol Rep. 2017;(6):39–47.
16.
Wilkerson R, Stone M. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med Off J Soc Acad Emerg Med. 2010;(1):11–7.
17.
Inaba K, Lustenberger T, Recinos G, Georgiou C, Velmahos G, Brown C. Does size matter? A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma. J Trauma Acute Care Surg. 2012;(2):422–7.
18.
Ganie F, Hussain S, Lone H, Wani M, Wani S. Carcinoma lung: Clinical presentation, diagnosis, and its surgical management. J Assoc Chest Physicians. 2013;(1):38.
19.
Cohn S, Dubose J. Pulmonary contusion: an update on recent advances in clinical management. World J Surg. 2010;(8):1959–70.
20.
Keneally R, Szpisjak D. Thoracic trauma in Iraq and Afghanistan. J Trauma Acute Care Surg. 2013;(5):1292–7.
21.
O’connor J, Kufera J, Kerns T, Stein D, Ho S, Dischinger P. Crash and occupant predictors of pulmonary contusion. J Trauma. 2009;
22.
23.
Becher R, Colonna A, Enniss T, Weaver A, Crane D, Martin R. An innovative approach to predict the development of adult respiratory distress syndrome in patients with blunt trauma. J Trauma Acute Care Surg. 2012;(5):1229–35.
24.
Raghavendran K, Notter R, Davidson B, Helinski J, Kunkel S, Knight P. Lung contusion: inflammatory mechanisms and interaction with other injuries. Shock Augusta Ga. 2009;(2):122–30.
25.
Tyburski J, Collinge J, Wilson R, Eachempati S. Pulmonary contusions: quantifying the lesions on chest X-ray films and the factors affecting prog-nosis. J Trauma. 1999;(5):833–8.
26.
Hosseini M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, Ghanbari H, et al. Diagnostic Accuracy of Ultrasonography and Radiography in Detection of Pulmonary Contusion; a Systematic Review and Meta-Analysis. 2015;(4):127–36.
27.
Madershahian N, Wittwer T, Strauch J, Franke U, Wippermann J, Kaluza M. Application of ECMO in multitrauma patients with ARDS as rescue therapy. J Card Surg. 2007;(3):180–4.
28.
Wen PH, Chan W, Chen YC, Chen YL, Chan CP, Lin PY. Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review. World J Emerg Surg WJES. 2015;15.
29.
Daurat A, Millet I, Roustan JP, Maury C, Taourel P, Jaber S. Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion. Injury. 2016;(1):147–53.
30.
Mommsen P, Zeckey C, Andruszkow H, Weidemann J, Frömke C, Puljic P. Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma. J Surg Res. 2012;(1):239–47.
31.
Sharma A, Jindal P. Principles of diagnosis and management of traumatic pneumothorax. J Emerg Trauma Shock. 2008;(1):34–41.
32.
Richter T, Ragaller M. Ventilation in chest trauma. J Emerg Trauma Shock. 2011;(2):251–9.
33.
Omar H, Abdelmalak H, Mangar D, Helal R, Camporesi E, E. Occult pneumothorax, revisited. J Trauma Manag Outcomes. 2010;12.
34.
Mohan P, Mohan R. Management of Warfare Chest Injuries. Med J Armed Forces India. 2010;66.
35. :
329–32.
36.
Boersma W, Stigt J, Smit H. Treatment of haemothorax. Respir Med. 2010;(11):1583–7.
37.
Wani L, Ahangar M, Wani A, Irshad S, Ul-Hassan I, N. Penetrating cardiac injury: a review. Trauma Mon. 2012;(1):230–2.
38.
Mcewan K, Thompson P. Ultrasound to detect haemothorax after chest injury. Emerg Med J EMJ. 2007;(8):581–2.
39.
Goodman M, Lewis J, Guitron J, Reed M, Pritts T, Starnes S. Video-assisted thoracoscopic surgery for acute thoracic trauma. J Emerg Trauma Shock. 2013;(6):106–9.
40.
Billeter A, Druen D, Franklin G, Smith J, Wrightson W, Richardson J. Video-assisted thoracoscopy as an important tool for trauma surgeons: a systematic review. Langenbecks Arch Surg. 2013;(4):515–23.
41.
Smith J, Franklin G, Harbrecht B, Richardson J. Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons. J Trauma. 2011;(1):105–7.
42.
Chou YP, Lin HL, Wu TC. Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma. Curr Opin Pulm Med. 2015;(4):393–8.
43.
Huang D, Zhao D, Zhou Y, Liu H, Chen X. Intrapleural Fibrinolytic Therapy for Residual Coagulated Hemothorax After Lung Surgery. World J Surg. 2016;(5):1121–8.
44.
Kimbrell B, Yamzon J, Petrone P, Asensio J, Velmahos G. Intrapleural thrombolysis for the management of undrained traumatic hemothorax: a prospective observational study. J Trauma. 2007;
45. :
1178–9.
46.
Lin HL, Huang WY, Yang C, Chou SM, Chiang HI, Kuo LC. How early should VATS be performed for retained haemothorax in blunt chest trauma? Injury. 2014;(9):1359–64.
47.
Huang WY, Lu IY, Yang C, Chou YP, Lin HL. Efficiency Analysis of Direct Video-Assisted Thoracoscopic Surgery in Elderly Patients with Blunt Traumatic Hemothorax without an Initial Thoracostomy. BioMed Res Int. 2016;3741426.
48.
Flaris A, Simms E, Prat N, Caillot R, Voiglio JL, E. Clamshell incision versus left anterolateral thoracotomy. Which one is faster when performing a resuscitative thoracotomy? The tortoise and the hare revisited. World J Surg. 2015;39.
49.
50.
Eren S, Esme H, Sehitogullari A, Durkan A. The risk factors and management of posttraumatic empyema in trauma patients. Injury. 2008;(1):44–9.
51.
Llompart-Pou J, Pérez-Bárcena J, Chico-Fernández M, Sánchez-Casado M, Raurich J. Severe trauma in the geriatric population. World J Crit Care Med. 2017;(6):99–106.
52.
Mitchell J. Blunt chest trauma: is there a place for rib stabilization? J Thorac Dis. 2017;(Suppl 3):211–7.
53.
Bemelman M, De Kruijf M, Van Baal M, Leenen L. Rib Fractures: To Fix or Not to Fix? An Evidence-Based Algorithm. Korean J Thorac Cardio-vasc Surg. 2017;(4):229–34.
54.
Mayberry J, Kroeker A, Ham L, Mullins R, Trunkey D. Long-term morbidity, pain, and disability after repair of severe chest wall injuries. Am Surg. 2009;(5):389–94.
55.
Campbell N, Conaglen P, Martin K, Antippa P. Surgical stabilization of rib fractures using Inion OTPS wraps--techniques and quality of life followup. J Trauma. 2009;(3):596–601.
56.
Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg. 2012;(2):201–5.
57.
Khoriati AA, Rajakulasingam R, Shah R. Sternal fractures and their management. J Emerg Trauma Shock. 2013;(6):113–6.
58.
Karangelis D, Bouliaris K, Koufakis T, Spiliopoulos K, Desimonas N, Tsilimingas N. Management of isolated sternal fractures using a practical algo-rithm. J Emerg Trauma Shock. 2014;(7):170–3.
59.
Guska S, Pilav I, Musanovic S. Clinical significance of isolated sternal fracture. Med Arh. 2010;(1):17–21.
60.
Harston A, Roberts C. Fixation of sternal fractures: a systematic review. J Trauma. 2011;(6):1875–9.
61.
Prokakis C, Koletsis E, Dedeilias P, Fligou F, Filos K. Dougenis trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg. 2014;117.
62.
Dwivedi S, Banode P, Gharde P, Bhatt M, Johrapurkar R, S. Treating traumatic injuries of the diaphragm. J Emerg Trauma Shock. 2010;(2):173–6.
63.
Makhani M, Midani D, Goldberg A, Friedenberg F. Pathogenesis and outcomes of traumatic injuries of the esophagus. Dis Esophagus Off J Int Soc Dis Esophagus. 2014;(7):630–6.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
