Search tips
Search criteria 


Logo of archemedLink to Publisher's site
Arch Emerg Med. 1989 June; 6(2): 97–106.
PMCID: PMC1285577

An audit of the management of 250 patients with chest trauma in a regional thoracic surgical centre.


Two hundred and fifty patients with chest trauma admitted consecutively over a 6-year period to the Royal Surrey County Hospital were reviewed. This is a large series by British standards. The cause and nature of their chest and associated injuries were studied, together with the management, complications and outcome. The aim of this study was to find areas where diagnosis and treatment could be improved. It was found that where there was no lung contusion, flail chest injuries could be managed without ventilation. The review suggests that even small traumatically induced pneumothoraces should be drained. It illustrates the need for an awareness of the wide range of concurrent problems in patients with chest injuries and the variety of possible complications.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Dougall AM, Paul ME, Finely RJ, Holliday RL, Coles JC, Duff JH. Chest trauma--current morbidity and mortality. J Trauma. 1977 Jul;17(7):547–553. [PubMed]
  • Fleming WH, Bowen JC. Early complications of long-term respiratory support. J Thorac Cardiovasc Surg. 1972 Nov;64(5):729–738. [PubMed]
  • Hamilton JR, Dearden C, Rutherford WH. Myocardial contusion associated with fracture of the sternum: important features of the seat belt syndrome. Injury. 1984 Nov;16(3):155–156. [PubMed]
  • James OF, Moore PG. Causes of death after blunt chest injury. Aust N Z J Surg. 1983 Feb;53(1):37–42. [PubMed]
  • Newman RJ. Chest wall injuries and the seat belt syndrome. Injury. 1984 Sep;16(2):110–113. [PubMed]
  • Phillips EH, Rogers WF, Gaspar MR. First rib fractures: incidence of vascular injury and indications for angiography. Surgery. 1981 Jan;89(1):42–47. [PubMed]
  • Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg. 1982 Oct;196(4):481–487. [PubMed]
  • Richardson JD, McElvein RB, Trinkle JK. First rib fracture: a hallmark of severe trauma. Ann Surg. 1975 Mar;181(3):251–254. [PubMed]
  • Shackford SR, Smith DE, Zarins CK, Rice CL, Virgilio RW. The management of flail chest. A comparison of ventilatory and nonventilatory treatment. Am J Surg. 1976 Dec;132(6):759–762. [PubMed]
  • Shackford SR, Virgilio RW, Peters RM. Selective use of ventilator therapy in flail chest injury. J Thorac Cardiovasc Surg. 1981 Feb;81(2):194–201. [PubMed]
  • Shin B, McAslan TC, Hankins JR, Ayella RJ, Cowley RA. Management of lung contusion. Am Surg. 1979 Mar;45(3):168–175. [PubMed]
  • Thompson GA, Wilson T, Collins RE, Broadley JA. Chest injuries in a district general hospital. Ann R Coll Surg Engl. 1982 Mar;64(2):117–120. [PMC free article] [PubMed]
  • Trinkle JK, Furman RW, Hinshaw MA, Bryant LR, Griffen WO. Pulmonary contusion. Pathogenesis and effect of various resuscitative measures. Ann Thorac Surg. 1973 Dec;16(6):568–573. [PubMed]
  • Trinkle JK, Richardson JD, Franz JL, Grover FL, Arom KV, Holmstrom FM. Management of flail chest without mechanical ventilation. Ann Thorac Surg. 1975 Apr;19(4):355–363. [PubMed]
  • Worthley LI. Thoracic epidural in the management of chest trauma. A study of 161 cases. Intensive Care Med. 1985;11(6):312–315. [PubMed]

Articles from Archives of Emergency Medicine are provided here courtesy of BMJ Publishing Group