Trauma remains one of the major causes of morbidity and mortality worldwide, particularly among young and economically productive age groups. Thoracic trauma is an important component of trauma admissions because the chest contains vital organs including the lungs, heart, great vessels and major airway structures. Injuries to the thoracic cage may range from simple chest wall abrasions and rib fractures to life-threatening conditions such as tension pneumothorax, massive hemothorax, flail chest, pulmonary contusion and major vascular injury [1,2].

Chest trauma contributes significantly to trauma-related deaths and is often associated with polytrauma. Blunt chest trauma is more common than penetrating trauma in civilian practice, especially in non-war settings. Road traffic accidents remain the leading cause of blunt thoracic trauma in many developing countries, including India. Increasing vehicular density, high-speed travel, poor road safety compliance and delayed trauma referral contribute to the burden of chest injuries [3,4].

The clinical outcome of blunt chest trauma depends on multiple factors including age, mechanism of injury, number of rib fractures, presence of hemothorax or pneumothorax, pulmonary contusion, flail chest, associated head or abdominal injuries and delay in presentation. Although some thoracic injuries are potentially fatal, a large proportion of patients can be managed by conservative measures, adequate analgesia, oxygen support, respiratory physiotherapy and intercostal chest tube drainage when indicated [5,6].

In Indian tertiary-care hospitals, many chest trauma patients are initially managed by general surgery and emergency teams. Dedicated thoracic trauma units may not be available in all centres. Therefore, hospital-based studies are useful to understand the local pattern of injury, common modes of trauma, treatment requirements and patient outcomes. Such data can help in improving trauma protocols, referral pathways and preventive strategies [7,8].

Previous studies have shown that young males are most commonly affected by chest trauma and road traffic injury is the predominant mode of trauma. Conservative management and tube thoracostomy remain the main treatment modalities in most cases, while thoracotomy is required only in a small subset of patients [9–11]. However, regional differences in mechanism of injury, referral pattern, associated injuries and outcomes make it necessary to study local data.

The present study was conducted to evaluate the clinical profile, injury pattern, management and outcome of blunt chest trauma patients admitted to a tertiary-care hospital.

Aim

To study the clinical profile, injury pattern, management and outcome of patients with blunt chest trauma admitted to a tertiary-care hospital.

Objectives

1. To assess the demographic profile, mode of injury and clinical pattern of blunt chest trauma.
2. To evaluate the management profile and outcome of patients with blunt chest trauma.

Study design This was a prospective observational study. Study setting The study was conducted in the Department of General Surgery / Cardiothoracic Surgery at a tertiary-care hospital. Study duration The study was conducted over a period of two years, from APRIL 2017 to MARCH 2019 Study population All patients admitted with blunt chest trauma during the study period were considered for inclusion. Sample size A total of 200 patients with blunt chest trauma were included in the study. Inclusion criteria 1. Patients admitted with blunt chest trauma. 2. Patients aged more than 12 years. 3. Patients with isolated chest trauma or chest trauma associated with other injuries. 4. Patients willing to participate in the study. Exclusion criteria 1. Patients with penetrating chest trauma. 2. Patients brought dead to the hospital. 3. Patients with incomplete clinical or radiological records. 4. Patients not willing to participate in the study. Data collection Data were collected using a structured proforma. The following parameters were recorded: • Age and sex • Mode of injury • Type of chest injury • Radiological findings • Associated injuries • Type of management • Requirement of intercostal chest tube drainage • Hospital outcome Management protocol All patients were evaluated initially according to standard trauma assessment principles. Airway, breathing and circulation were assessed at admission. Chest X-ray and/or CT chest were performed based on clinical indication. Patients with minor chest wall injuries were managed conservatively with analgesics, oxygen support, respiratory physiotherapy and observation. Intercostal chest tube drainage was performed in patients with clinically significant pneumothorax, hemothorax or hemopneumothorax. Patients with associated severe injuries were managed with multidisciplinary care. Statistical analysis Data were entered in Microsoft Excel and analysed using statistical software. Categorical variables were expressed as frequency and percentage. Continuous variables were expressed as mean and standard deviation. Chi-square test was used for comparison of categorical variables wherever applicable. A p value of less than 0.05 was considered statistically significant.

A total of 200 patients with chest trauma were included in the study. There were 141 males and 59 females, with a male-to-female ratio of approximately 2.4:1.

Table 1. Demographic profile of patients

The most commonly affected age group was 21–30 years, comprising 61 patients (30.50%), followed by 41–50 years, comprising 48 patients (24.00%).

Table 2. Mode of injury

Road traffic injury was the most common mode of trauma, seen in 118 patients (59.00%), followed by assault in 72 patients (36.00%).

Table 3. Type of chest injury

Abrasions were the most common chest injury, observed in 83 patients. Rib fractures and hemothorax were each seen in 33 patients, while pneumothorax was seen in 17 patients. Severe injuries such as flail chest and pulmonary contusion were less common.

Table 4. Management profile

Most patients were managed conservatively, accounting for 111 cases (55.50%). Intercostal chest tube drainage was required in 74 patients (37.00%).

Table 5. Outcome of patients

Most patients had a favourable outcome, with 159 patients (79.50%) discharged in satisfactory condition. Mortality was low, with 3 deaths (1.50%).

Figure 1. Age-wise Distribution of Patients

Figure 2. Mode of Injury

Figure 3. Pattern of Chest Injuries

Figure 4. Management Profile

Figure 5. Clinical Outcome

Chest trauma remains an important component of trauma-related morbidity and mortality, particularly in low- and middle-income countries where road traffic injuries continue to contribute substantially to emergency surgical admissions. In the present study of 200 patients, blunt chest trauma predominantly affected young adult males, with the highest proportion in the 21–30 years age group (30.50%), followed by the 41–50 years age group (24.00%). The male predominance observed in the present study, with a male-to-female ratio of approximately 2.4:1, is consistent with previous Indian studies, where greater outdoor mobility, occupational exposure, driving patterns, and higher involvement in road traffic accidents among males have been described as important contributing factors [12,13]. Road traffic injury was the leading mode of trauma in the present study, accounting for 118 patients (59.00%), followed by assault in 72 patients (36.00%). This finding is comparable to Walia et al., who reported road traffic injuries as the most common cause of chest trauma in an Indian tertiary-care centre [12]. Similarly, recent Indian studies on blunt chest trauma have also identified road traffic accidents as the major mechanism of injury, particularly among young and middle-aged males [13,14]. The high proportion of road traffic injuries highlights the continuing need for preventive strategies such as helmet and seat-belt enforcement, speed control, alcohol-use restriction while driving, and early trauma referral systems. In the present study, superficial chest wall injuries were common, with abrasions observed in 83 cases, followed by bruises in 33 cases. Among clinically significant thoracic injuries, rib fractures and hemothorax were each noted in 33 patients, while pneumothorax was present in 17 patients. Flail chest and pulmonary contusion were comparatively less frequent. These findings indicate that although many patients present with minor chest wall injuries, a significant subset requires careful radiological evaluation to detect hemothorax, pneumothorax, rib fractures, and pulmonary contusion. Shandilya et al. studied blunt chest injury patients with limited rib fractures and showed that even apparently stable chest wall injuries may require structured observation and selective intervention [13]. Management in the present study was predominantly non-operative. Conservative management was sufficient in 111 patients (55.50%), while 74 patients (37.00%) required intercostal chest tube drainage. Only 15 patients (7.50%) required suturing under local anaesthesia. This pattern supports the widely accepted observation that most blunt chest trauma cases can be managed with analgesia, oxygen support, chest physiotherapy, respiratory monitoring, and tube thoracostomy when indicated [12,15]. Walia et al. also reported that the majority of chest trauma patients were managed conservatively, with tube thoracostomy required in selected patients [12]. Similarly, Shandilya et al. showed that conservative treatment can be effective in carefully selected patients with blunt chest injury and limited rib fractures, while intercostal drainage remains necessary when pneumothorax or hemothorax is clinically significant [13]. The outcome profile in the present study was favourable. A total of 159 patients (79.50%) were discharged satisfactorily, while 33 patients (16.50%) left against medical advice, 5 patients (2.50%) were referred, and 3 patients (1.50%) expired. The low mortality rate is comparable to Walia et al., who reported mortality of 1.63% in chest trauma patients, with deaths mainly occurring among polytrauma patients with associated head or abdominal injuries [12]. This suggests that isolated blunt chest trauma usually has good prognosis when identified early and managed appropriately, whereas mortality is more likely when thoracic injury occurs as part of polytrauma. Risk stratification is increasingly important in blunt chest trauma. Recent literature has evaluated tools such as the STUMBL score to predict complications, ICU admission, and need for higher-level care. Dhillon et al. reported the usefulness of the STUMBL score in clinical risk stratification of blunt chest trauma patients in an Indian tertiary-care setting [16]. However, Callisto et al. observed that STUMBL score performance may not always be superior to experienced emergency clinician judgement, indicating that scoring tools should complement, rather than replace, clinical assessment [17]. In the Indian scenario, such scoring systems may be useful for triage, especially in centres where dedicated thoracic trauma units are not available. The findings of the present study also support the importance of early imaging and protocol-based management. Chest X-ray remains useful as an initial investigation, but CT chest can detect occult pneumothorax, pulmonary contusion, small hemothorax, and associated skeletal injuries more accurately. Current blunt chest trauma guidelines emphasize early identification of respiratory compromise, adequate analgesia, pulmonary hygiene, and escalation of care for patients with multiple rib fractures, flail chest, pulmonary contusion, or worsening oxygenation [18]. These principles are particularly relevant in tertiary-care hospitals where chest trauma is commonly managed by general surgery, emergency medicine, and critical care teams. Overall, the present study confirms that blunt chest trauma in the Indian tertiary-care setting primarily affects young males, most commonly following road traffic injury. The majority of patients can be managed conservatively or with intercostal chest tube drainage, and mortality remains low when injuries are promptly recognized and treated. However, associated polytrauma, delayed referral, pulmonary complications, and lack of structured trauma systems remain important concerns. Preventive public health measures and standardized hospital-based chest trauma protocols may further reduce morbidity and mortality. Limitations This was a single-centre study with a limited sample size. Long-term follow-up after discharge was not included. The severity of associated injuries and detailed trauma scoring were not analysed in all patients. Multicentric studies with larger sample size and follow-up are needed to validate the findings.

Blunt chest trauma commonly affects young adult males, with road traffic injury being the most common mode of trauma. Most patients present with minor chest wall injuries, while hemothorax, pneumothorax and rib fractures are important clinically significant findings. Conservative management is sufficient in the majority of patients, while intercostal chest tube drainage is required in selected cases. Mortality is low when early diagnosis, appropriate supportive care and timely intervention are provided.

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