Volume 28, Issue 148, June 2024

Approach to chest trauma management in emergency department: Systematic review

Ahmed Hadi Khormi¹, Mazi Mohammed Alanazi², Malek Shafif Alenezi³, Muhannad Abdulrazaq M Almesned³

¹Saudi Board Emergency Medicine, Emergency Medicine Residency Program Director, Imam Abdulrahman AlFaisal Hospital, First Health Cluster, Riyadh, Saudi Arabia
²Head of Emergency Research Unit, Emergency Medicine, Imam Abdulrahman AlFaisal Hospital, First Health Cluster, Riyadh, Saudi Arabia
³Saudi Board Emergency Medicine Resident, First Health Cluster, King Saud Medical City Riyadh, Saudi Arabia

ABSTRACT

Background: Over 10% of all injuries treated in emergency departments are thoracic traumas, with over 70% of these instances being blunt thoracic trauma. In this study, we aimed to systematically review articles discussing the management of chest trauma in the emergency department. Method: This systematic review complied with the PRISMA statement. After searching the databases of Medline, Embase, PubMed, and CINHAL for pertinent publications published between 2012 and 2024, we included 5 RCTs, 3 observational studies, and 1 case-control study. Results: Immediate care intervention for blunt thoracic injuries was covered by 4 articles in our review. Empyema rates following insertion of a chest drain, ICU need for admission, mortality, and hospital and, ICU LOS were the outcome measures taken by the 4 studies. Standardized formal training for resident medical professionals was the intervention used. Five publications covered the management of multiple rib fractures following chest trauma. Three randomized controlled trials included patients with flail segment and clinical flail chest; one study included patients with flail segment but no flail chest; and one research included individuals with simple rib fractures but no clinical or radiological flail chest. Conclusion: Surgical stabilization of multiple rib fractures reduced the duration of mechanical ventilation and the incidence of pneumonia compared with conservative care, but there was no clear improvement in mortality. The length of hospital and intensive care unit stays, as well as empyema incidences, significantly decreased following the adoption of patient pathway-based intervention for medical staff in the emergency department.

Keywords: Chest trauma, emergency department, management, systematic review

Medical Science, 2024, 28, e59ms3354

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DOI: https://doi.org/10.54905/disssi.v28i148.e59ms3354

Published: 18 June 2024