Presentation, management and outcome of thoracic trauma in a resource-limited environment: A case series

Abstract

Background

Trauma is a major public health problem, causing the death of >5 million people each year. One-fifth of these deaths are related to thoracic trauma (TT). This study aims to provide data on the presentation, management, and outcome of TT at the State University Hospital of Haiti (HUEH).

Methods

This is a retrospective, single-center, formal case series of 35 cases of TT admitted to the General Surgery Department of HUEH from January 2013 to December 2017. Data analyzed included sociodemographic, preoperative (etiology and clinical presentation), management, and outcomes. The Exact Fischer, Welch and Mann-Whitney U tests were used. A P-value p < 0.05 was considered significant. The case series was reported according to PROCESS criteria.

Results

Of our sample of 35 patients, there was a male predominance (n = 27, 77.1 %), and the median age was 40 years. Most patients (n = 33, 94.3 %) presented with penetrating TT. The principal etiology was assaults (n = 30, 85.7 %), committed mostly by strangers (n = 19) and mainly with firearms (n = 18). Topping the list of common thoracic injuries were hemopneumothorax, diaphragmatic tear and open pneumothorax. There were extrathoracic associated injuries in 16 patients (45.7 %) with abdominal involvement in 10 cases (28.6 %). Principal specific management was tube thoracostomy for 33 patients (94.3 %) with additional laparotomy for 12 patients (34.3 %) for a median hospital stay of 6 days. There were 2 deaths due to massive hemorrhage without the possibility of massive transfusion. Estimated blood loss was significantly related to short-term survival outcome (p = 0.02).

Conclusion

This is a rare study in the Haitian environment that explores TT. Rather than road traffic accidents, assaults caused mainly by firearms were the chief cause of TT and testify to the current climate of violence and insecurity in the country. Although most of the TT cases were manage by tube thoracostomy, one third needed additional laparotomy. Increased blood loss associated with poorer patient outcomes highlights the need for more transfusion services and the establishment of standard of care for TT in Haiti.