The Pattern and Management of Chest Trauma at Muhimbili National Hospital, Dar es Salaam

Background: Chest trauma is common and its pattern varies in different places. Majority of patients are managed mainly conservatively. Tube thoracostomy is a simple procedure but it is associated with significant number of complications. The aim of this study was to evaluate the clinical pattern and its management at Muhimbili National Hospital. Methods: A hospital based prospective study of all consecutive patients admitted with chest trauma at Muhimbili National Hospital between November 2007 and September 2008. Clinical assessment and chest x-ray findings were used to diagnose and to evaluate any complications associated with chest tubes using a structured questionnaire. Results: The majority (95/119) of patients were males. Their age ranged from 12 to 72 years with the mode of 32 years. Motor traffic injury (MTI) was the commonest cause of chest trauma accounting for 72.3% of the cases. Rib fractures were the most clinical type of chest injury and accounted for about 42.9% of cases. Blunt chest injuries were more common (75.6%) than penetrating injuries. Seventy three (61.3%) patients had other associated injuries, in which fracture of extremities (25.2%) and head injury (21.8%) were the commonest. Sixty seven (56.3%) patients were treated with closed tube thoracostomy only. The overall complication rate of the chest tubes was 32.9% of which infection (24.7%) and nonfunctional tubes (17.4%) were the commonest. High mortality rate of 24.2% was recorded. Conclusion: The clinical pattern and the management of chest injuries in this study was similar with many other series of study, however, the rate of closed tube thoracostomy remained high with many and avoidable complications