Clinical, operative and pathological correlations in fatal and near-fatal thoracic trauma in Nigerians

Abstract

A combined retrospective and prospective review of 248 chest trauma patients has been carried out at the University of llorin Teaching Hospital between 1979 and 1986. Eight and 12 of these patients respectively were so severely injured that they were certified dead on arrival in the Emergency Room or at varying periods during resuscitation but before definitive management. Ten others were subjected to major operation. The peculiar clinical features of this sub-group of 30 patients within the context of the entire series are analysed in detail and correlated with autopsy and operative findings in 20 and 10 patients respectively. Most (36.7%) of the severe injuries occurred in the 21-30 age group followed by children under 10 years of age (16.7%). When injuries are classified into life-threatening, potentially life-threatening and mild (including incidental pathology found at autopsy), the majority (95%) of autopsy cases sustained multiple trauma combining cranio-encephalic, abdominal, extremity and spinal injuries, in descending order, with chest trauma. Penetrating trauma constituted 50% of the thoracotomy group while all but one of 20 autopsy cases sustained blunt injuries. Multiple rib fractures including proximal ones were common. No major tracheobronchial or aortic disruptions were encountered while two cases of heart injury were seen. Suggestions are made towards decreasing the injury treatment interval, improving the general level of preparedness and diagnosis of visceral injury despite more obvious non-visceral trauma.