Penetrating chest injuries in civilian practice

The purpose of this retrospective study is to show the pattern of penetrating chest injury, methods of management and the outcome. Were viewed all consecutive penetrating chest injured patients admitted to the Cardiothoracic Surgical Unit of the University College Hospital, Ibadan between May 1975 and April 1999. We found that 597 patients had penetrating chest injuries. This was 31% of all chest injuries treated. To analyse pattern of injuries, period of study was divided into 2 periods of 12 years each, May 1975 to April 1987 (Group A) and May 1987 to April 1999 (Group B). Mean ages of the patients in group A and B were, respectively, 27 +/- 12.5years and 48 +/- 10.2 years; male:female ratio for the 2 groups were 20:1 and 17:1, respectively. The main mechanisms of injury were gunshot wounds (GSW) in 364 patients (61%) and stab wounds (SW) in 214 patients (35.8%). The ratio of GSW to SW was reversed for the 2 periods, 1:3 for group A and 7:1 for group B. Nine patients died during resuscitation. Four hundred and eleven patients of 588 patients (69.9%) were managed conservatively. Sixty-five (11.1%) by clinical observation and 346 (58.8%) by closed thoracostomy drainage. Mortality among the conservatively managed was 2.2%, morbidity was 18.2% (75 out of 411 patients). Ninety patients had early major surgery, 75 had late major surgical management of complication of conservative management. The operative mortality was 22% (in 39 patients). The determinant of mortality were haemorrhage, respiratory insufficiency and sepsis. We conclude that penetrating injury is a third of chest injuries we see. It is commoner in men and currently involves the older age group and it is most frequently inflicted by gunshot. Majority may be managed conservatively with low incidence of complications. Prompt major surgery limits mortality among the salvageable.