Blunt chest injuries in 1696 patients

We review 1696 patients with blunt chest trauma. Road traffic accidentswere the main cause of injury followed by domestic falls and labouraccidents. Outdoor falls and sport accidents accounted for a small numberof injuries. For clinical evaluation, Stoddart's score was used. Theinjuries were considered as minor in 710 patients, intermediate in 740 andsevere in 246. Global in-hospital mortality was low (5%) but increased to37% when only patients with multiple severe injuries were considered.Thoracic wall fractures were present in 1419 patients. Flail chest wasdiagnosed in 140 patients and pulmonary contusion in 275. Diaphragmaticrupture was present in 40 patients and tracheobronchial injury in 6.Cardiovascular injuries occurred in 55 patients. Associated extrathoracicinjuries were seen in 611 patients: 923 patients were clinically observedand/or medically treated. An intercostal tube was inserted in 638 patients.Thoracotomy was undertaken in 105 patients. Surgical fixation for flailchest was carried out in 29 patients. The results were generally good: 9patients did not need any mechanical ventilation and 11 were ventilated fora short period. No deaths were due to the surgical procedure. The authorsmaintain that a selective attitude restricting, but not ignoring, surgicalstabilization is the best policy.