The management of blunt thoracic trauma

DOI 0.1093/bjacepd/mkg171 Trauma accounts for more than 9000 deaths per annum in the UK. One-third are due to road traffic accidents and chest injuries are responsible for one in four of these deaths. They also play a significant part in 25% of other trauma deaths. Patients admitted with chest injuries often have associated multiple injuries. It is usual for many specialities to share the care of the multi-injured patient. Therefore, good communication is essential. Rapid access to tertiary care surgical services (e.g. cardiothoracic and neurosurgery) are required and access to critical care physicians may improve outcome. Many patients with chest injuries die after admission to hospital and up to one-third of these may be preventable. In 1992, the major trauma outcome study report found that outcome from blunt trauma varied between hospitals in the UK and was worse than that in the US. In 2002, a joint report from The Royal College of Surgeons of England and the British Orthopaedic Association produced recommendations aimed at improving outcome from severe trauma. Recommendations included establishing a national trauma research network, geographically-based trauma systems and the auditing of standards. This document recognised that many patients with chest injuries will be treated by non-cardiothoracic specialists. The occult nature of underlying injuries and difficulties in clinical examination may lead to under-diagnosis of potentially lifethreatening injuries. Further recommendations included investigations targeted to the mode of injury, early specialist intervention and repeated clinical and radiological investigations.