Trauma represents the third most common cause of death across all age groups, following cardiovascular diseases and cancer [1]. It remains the leading cause of mortality among individuals in the first four decades of life [2]. Thoracic injuries, in particular, contribute substantially to trauma-related mortality, with approximately one in four trauma patients succumbing to chest trauma or its sequelae [3]. The increasing incidence of chest injuries has been attributed largely to high-velocity road traffic accidents. According to the National Trauma Database (NTDB), chest trauma is reported in 13.8% of all blunt trauma cases, with an overall mortality rate of 8.4% [4]. The mortality associated with blunt thoracic trauma ranges between 9.5% and 47.5%, depending on the severity of the injury. Road traffic accidents account for 70–80% of thoracic trauma, followed by falls [5]. Thoracic trauma can be broadly classified into penetrating and blunt injuries. Penetrating injuries, often caused by firearms or sharp objects, directly disrupt tissue integrity, whereas blunt trauma damages underlying organs without breaching structural continuity. The primary causes of blunt injuries include road traffic accidents, falls from heights, and occupational mishaps. Notably, 70% of all chest trauma is blunt in nature [6,7], and blunt thoracic trauma accounts for nearly 15% of all trauma cases worldwide [8,9]. The initial assessment of chest trauma patients requires rapid identification and management of six life-threatening conditions: airway obstruction, tension pneumothorax, open pneumothorax, massive hemothorax, flail chest, and pericardial tamponade [10]. Among these, five are directly related to lung and chest wall injuries. Other potentially fatal complications include pulmonary contusion, tracheobronchial disruption, diaphragmatic rupture, myocardial contusion, thoracic aortic injury, and esophageal tears. Of note, pulmonary injuries constitute two of the six most critical trauma-related conditions, underscoring the vital role of respiratory compromise in thoracic trauma. Given that blunt chest trauma may affect multiple systems within the thoracic cavity, a multidisciplinary management approach is essential. While only 10% of patients with blunt chest trauma require surgical intervention, the majority can be managed conservatively [3,9,11]. Standard treatment modalities include airway assessment and oxygen supplementation [12], tube thoracostomy [13], fluid resuscitation, pulmonary hygiene, and adequate analgesia [14]. Patient age is a critical determinant of clinical outcomes. Due to the elasticity of their rib cage, children often sustain fewer fractures in blunt trauma, though significant internal injury may still occur. Conversely, older adults, with reduced bone elasticity, are at greater risk of sustaining multiple fractures even from minor trauma. Additional prognostic factors influencing morbidity and mortality include the number of rib fractures, requirement for mechanical ventilation, pre-existing pulmonary disease, associated head injury, hypotension, and injuries involving extra-thoracic organs [15]. Furthermore, a low Glasgow Coma Scale (GCS) score in chest trauma patients strongly predicts mortality [16]. Although thoracotomy is rarely required in blunt trauma, it is more commonly indicated in cases of penetrating thoracic injuries. Early recognition of high-risk patients is crucial to avoid treatment delays that may increase morbidity and mortality. Most cases of chest trauma are preventable, highlighting the importance of public health interventions. A detailed understanding of the epidemiology, injury mechanisms, and outcomes is imperative to develop effective prevention strategies and optimize management protocols. Based on this rationale, the present study was undertaken to analyze the pattern of blunt chest trauma and its management in tertiary care hospitals.

This study was designed as a prospective observational study and was conducted in the Department of General Surgery, Sir T Hospital, Bhavnagar, after obtaining approval from the Institutional Ethics Committee of Government Medical College, Bhavnagar. The study population comprised patients above 18 years of age admitted with blunt chest trauma in the inpatient department of General Surgery. Patients were enrolled over a 24-month period from October 2022 to September 2024. A total of 50 patients who fulfilled the inclusion criteria and presented during the study period were included using a time-bound sampling method. The inclusion criteria consisted of all patients older than 18 years presenting with blunt chest trauma. Pregnant women were excluded from the study. Written informed consent was obtained from each participant prior to data collection. In cases where the patient was unable to provide consent, consent was obtained from a relative or a witness. Confidentiality and privacy of participants were strictly maintained throughout the study. For each enrolled patient, detailed demographic information, trauma history, clinical presentation, diagnosis, and management details were recorded. Patients were followed throughout their hospital stay until completion of their management. Data were collected using a pre-tested, pre-validated, semi-structured questionnaire, available in English and Gujarati, and administered in the language preferred by the patient. Data were entered in Microsoft Excel 2019 with double-entry verification for accuracy and analyzed using MedCalc and Epi Info 7.1 software. Qualitative variables were expressed as proportions and percentages, while quantitative variables were tested for normality and presented as mean ± standard deviation (SD). Statistical comparisons were performed using the Student’s t-test and chi-square test, with p < 0.05 considered significant.

This prospective study was conducted over a period of 24 months at Sir T Hospital, Bhavnagar, Gujarat, India, and included fifty patients diagnosed with blunt chest trauma. The analysis focused on evaluating the distribution of cases according to age, gender, etiology of injury, injury patterns, and the type of management required in different clinical scenarios. Table 1. Age and Gender-wise Distribution of Blunt Chest Trauma Age (years) Male (Frequency) Male (%) Female (Frequency) Female (%) Total (n=50) < 30 9 25% 1 7.5% 10 30–60 21 58% 9 64% 30 > 60 6 17% 4 28.5% 10 Total 36 72% 14 28% 50 Table 1 presents the age- and gender-wise distribution of patients with blunt chest trauma. The majority of cases occurred in the 30–60 years age group (60%), followed by patients aged <30 years (20%) and those >60 years (20%). Males constituted a larger proportion overall (72%) compared to females (28%). Across all age groups, male predominance was observed, with the highest representation in the 30–60 years age group (58% of males and 64% of females). Table 2. Age and Gender-wise Distribution of Cause of Injury Cause of Injury Male (n) Female (n) <30 y (n) 30–60 y (n) >60 y (n) Vehicular accident 19 4 3 15 5 Fall from height 8 4 3 7 2 Blunt object injury 9 6 4 8 3 Table 2 illustrates the age- and gender-wise distribution of causes of injury among blunt chest trauma patients. Vehicular accidents emerged as the predominant cause, accounting for 23 cases (46%), with a higher incidence in males (n=19) and in the 30–60 years age group (n=15). Falls from height contributed to 12 cases (24%), distributed almost equally across genders (8 males, 4 females), and were most frequent in the 30–60 years age group (n=7). Blunt object injuries accounted for 15 cases (30%), showing a relatively higher burden among females (n=6) compared to other causes, with the majority also occurring in the 30–60 years group (n=8). Table 3. Distribution of Pattern of Injury in Blunt Chest Trauma Type of Injury Involving Specific Injury Frequency Percentage Chest wall & ribs Chest wall contusion 19 38.0% Fracture of ribs 25 50.0% Flail chest 1 2.0% Pleural cavity Haemothorax 6 12.0% Pneumothorax 3 6.0% Haemo-pneumothorax 11 22.0% Lung parenchyma Lung contusion 6 12.0% Subcutaneous emphysema 13 26.0% Table 3 illustrates the distribution of injury patterns among patients with blunt chest trauma. Chest wall and rib injuries were the most prevalent, with rib fractures constituting the majority (50%), followed by chest wall contusions (38%), while flail chest was infrequently encountered (2%). Involvement of the pleural cavity was characterized predominantly by haemopneumothorax (22%), with haemothorax (12%) and pneumothorax (6%) observed less frequently. Injuries affecting the lung parenchyma included subcutaneous emphysema (26%) and lung contusion (12%). Collectively, rib fractures and subcutaneous emphysema emerged as the most common injury patterns in this study cohort, underscoring their clinical relevance in the spectrum of blunt thoracic trauma. Table 4. Gender Distribution of Type of Management Type of Management Male (n=36) Female (n=14) Total (n=50) ICD Insertion 14 (39%) 4 (29%) 18 Conservative 22 (61%) 10 (71%) 32 Total 36 14 50 Table 4 demonstrates the gender distribution of management strategies in patients with blunt chest trauma. Out of the total 50 patients, conservative management was the predominant modality, applied in 32 cases (64%). Among males, 22 patients (61%) were managed conservatively, while 14 (39%) required intercostal drain (ICD) insertion. Similarly, in females, conservative management was preferred in 10 cases (71%), whereas only 4 (29%) required ICD insertion. Overall, the findings indicate that the majority of blunt chest trauma cases can be managed conservatively, with ICD insertion reserved for selected cases, without substantial gender-related differences in management approach. Table 5. Association of Cause of Injury with Type of Management Cause of Trauma Conservative (n=32) ICD Insertion (n=18) Frequency % Frequency % Blunt Object Injury 9 60% 6 40% Fall From Height 8 66% 4 44% Vehicular Accident 15 65% 8 35% Total 32 — 18 — Table 5 demonstrates the association between the cause of injury and the type of management in blunt chest trauma cases. Out of 50 patients, conservative management was more frequently adopted (n=32) compared to intercostal drain (ICD) insertion (n=18). Among those with blunt object injuries, 60% were managed conservatively and 40% required ICD insertion. Similarly, fall from height cases were predominantly treated conservatively (66%), while 44% underwent ICD insertion. In vehicular accidents, 65% of patients were managed conservatively and 35% required ICD insertion. Overall, conservative management remained the primary modality across all mechanisms of trauma, irrespective of the cause. Table 6. Association of ICD Insertion and Conservative management with Type of Injury Type of Injury Number of ICD Insertions Conservative Management Chest wall contusion only 0 19 Lung contusion only 1 1 Fracture of ribs only 0 9 Subcutaneous emphysema only 0 2 Hemopneumothorax 17 3 Total 18 32 Table 6 illustrates the association between type of injury and the mode of management in patients with blunt chest trauma. Out of 50 cases, ICD insertion was required in 18 patients, while 32 were managed conservatively. Patients with isolated chest wall contusion (n=19), rib fractures (n=9), and subcutaneous emphysema (n=2) were managed exclusively with conservative treatment. Similarly, most patients with isolated lung contusion (n=1) were managed conservatively, with only a single case requiring ICD insertion. In contrast, the majority of patients with haemopneumothorax (n=20) required ICD insertion (85%), highlighting a strong association between this specific injury pattern and the need for surgical intervention. Overall, the data indicate that while most blunt chest trauma injuries can be managed conservatively, haemopneumothorax significantly increases the likelihood of requiring ICD placement. Table 7. Association of pattern of injury with type of management Pattern of Injury Management Total Chi-square P value Conservative ICD Insertion Chest wall contusion Present 19 0 19 0.0001 Absent 13 18 31 Lung contusion only Present 1 1 2 0.3 Absent 31 13 44 Fracture of ribs only Present 6 0 6 0.3 Absent 23 2 25 Hemo-pneumothorax Present 3 17 20 0.001 Absent 29 1 30 Table 7 demonstrates the association between specific patterns of injury and the type of management in blunt chest trauma cases, along with corresponding chi-square values. Chest wall contusion (n=19) was managed exclusively with conservative treatment, showing a statistically significant association (p = 0.0001). Similarly, haemopneumothorax (n=20) showed a strong and significant association with ICD insertion, with 85% of cases requiring intervention (p = 0.001). In contrast, injuries such as isolated lung contusion (n=2) and rib fractures (n=6) did not demonstrate statistically significant associations with the type of management (p = 0.3 for both), indicating that these injuries may be treated successfully with either conservative or interventional approaches depending on severity. Overall, the findings suggest that chest wall contusion is predominantly managed conservatively, whereas haemopneumothorax strongly predicts the need for ICD insertion. Table 8. Associate injury and ventilatory support Parameters Frequency Percentage Associated Injury Blunt abdominal Injury 14 28% Head injury 22 44% Required Ventilatory support Blunt chest trauma 2 12.5% Blunt abdominal Injury 1 6.25% Head injury 13 81.25% Table 8 presents the distribution of associated injuries and their relationship with the requirement for ventilatory support in patients with blunt chest trauma. The most frequent associated injury was head injury (44%), followed by blunt abdominal injury (28%). With respect to ventilatory support, the majority of patients requiring it had sustained head injury (81.25%), whereas only 12.5% and 6.25% required ventilatory support due to isolated blunt chest trauma and blunt abdominal injury, respectively. These findings highlight that head injury was not only the most common associated injury but also the predominant determinant for ventilatory support, underscoring its clinical significance in the overall management and prognosis of blunt chest trauma cases.

In the present study, the mean age of patients with blunt chest trauma was 44 ± 16.45 years, with the majority of cases falling within the 30–60 years age group. This indicates that middle-aged adults are the most commonly affected demographic, which may be related to their higher involvement in occupational, vehicular, and outdoor physical activities. By contrast, Sharma et al. [17] reported a significantly higher mean age of 59.6 ± 1.5 years, with the predominant age group being 55–65 years. This suggests a shift of incidence towards an older population in their study cohort. The discrepancy between the two studies may be attributed to differences in sample characteristics, regional variations, and the predominant mechanisms of injury. For example, younger age groups are more likely to be exposed to high-energy trauma, such as road traffic accidents and industrial injuries, whereas older individuals may sustain blunt chest trauma more frequently due to falls, decreased reflexes, or comorbidities that predispose them to injury. Overall, while both studies emphasize adult predominance in blunt chest trauma, the present study highlights involvement of a relatively younger population compared to the findings of Sharma et al.,[17] underlining the influence of demographic and epidemiological factors on age distribution. In the present study, blunt chest trauma was predominantly observed in males (72%), while females accounted for 28% of cases. This finding is closely aligned with the results reported by Lee RB et al.,[18] who also demonstrated a male predominance (70%) compared to females (30%). The similarity between these two studies suggests a consistent gender distribution pattern across different populations, reinforcing the notion that males are more frequently exposed to high-risk activities and occupational hazards contributing to blunt chest trauma. However, when compared to the findings of Saaiq M et al.,[19] the male predominance appears to be even more pronounced, with 83% of cases occurring in males and only 17% in females. This disparity may be attributed to differences in sociocultural factors, modes of injury, or referral patterns in the respective study populations. Nonetheless, all three studies uniformly demonstrate that blunt chest trauma occurs more frequently in males, highlighting gender as an important epidemiological determinant in thoracic injuries. In the present study, vehicular accidents were the most common cause of blunt chest trauma, accounting for 46% of cases. This finding is lower than that reported by Lee RB et al., who documented vehicular accidents as the predominant cause in 70% of cases [18]. The lower proportion in our study may reflect regional variations in traffic density, road safety measures, and enforcement of traffic regulations. Blunt object injury was observed in 30% of cases in our study, which is considerably higher than the 8% reported by Lee RB et al. [18]. This difference may be attributed to occupational hazards, interpersonal violence, or regional differences in mechanisms of trauma. Fall from height was identified in 24% of patients in our study, which is comparable to the 22% observed in the study by Lee RB et al. [18]. This similarity suggests that falls from height constitute a consistent mechanism of blunt chest trauma across different populations. Overall, the findings emphasize that while vehicular accidents remain a leading cause of blunt chest trauma across studies, the relative contribution of other mechanisms such as blunt object injuries may vary significantly depending on demographic, occupational, and regional risk factors. In the present study, chest wall contusion was observed in 38% of cases, whereas comparable data were not provided in the studies by Atri M et al., and K. Sharma et al. Rib fracture was the most common injury in our study, noted in 50% of cases, which is slightly lower than the incidence reported by Atri M et al. (60%), and K. Sharma et al. (71%) [17,20]. The occurrence of flail chest in the present study was 2%, which is lower than that reported by Atri M et al. (6.2%) [20]. Haemo-pneumothorax was documented in 40% of patients in our study, which is also lower compared to Atri M et al. (51.7%) [20]. Lung contusion was seen in 12% of patients in the current study, which is comparable to Atri M et al. (10.4%) [20]. Subcutaneous emphysema was present in 26% of patients in our study, whereas Atri M et al. reported a higher incidence of 37.9% [20]. Overall, the findings of the present study show that while rib fractures remain the most frequent injury across all studies, the proportion of associated complications such as haemo-pneumothorax and subcutaneous emphysema varies, likely reflecting differences in trauma mechanisms, diagnostic modalities, and study populations. In the present study, 64% of patients with blunt chest trauma were managed conservatively, while 36% required intercostal chest drain (ICD) insertion, and none underwent thoracotomy. When compared to Adegboye VO et al.,[21] a similar trend was noted, with 72.9% managed conservatively and 27.1% requiring ICD insertion, while thoracotomy was not performed in their cohort either. However, in contrast, K. Sharma et al. reported a much higher proportion of patients (93.6%) managed conservatively, with only 6.4% requiring ICD insertion, and no thoracotomy cases. This comparison highlights that the proportion of patients requiring ICD insertion in the present study (36%) was higher than that observed by both Adegboye VO et al. (27.1%) and Sharma et al.[17,21] (6.4%). Conversely, the rate of conservative management was relatively lower in the present study compared to both Adegboye VO et al. and Sharma et al.[17,21] These differences could be attributed to variations in the severity of chest injuries, patient selection criteria, or institutional management protocols across the studies. Importantly, none of the three studies, including the present one, reported the need for thoracotomy, suggesting that such invasive interventions remain uncommon in blunt chest trauma when managed promptly and appropriately.

Blunt chest trauma was more common in males, predominantly caused by road traffic accidents. Rib fractures were the most frequent injury, usually managed conservatively. Hemopneumothorax showed a significant correlation with the need for ICD insertion. HRCT proved superior to chest radiography for evaluating injury patterns, while ventilatory support was rarely required unless associated with head or abdominal trauma.

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