Predictors of pneumothorax in motor vehicle accident (MVA) survivors who sustain chest trauma
Thesis (MMed)--Stellenbosch University, 2013.
Pneumothorax is a relatively common1 and potentially fatal complication of MVA.2 The incidence of pneumothorax in MVA was found to be 38% in Cape Town1 and 54.6% in India.3 Pneumothorax may be missed during clinical assessment. An audit of paramedic records from 2000-2001 in Melbourne, Australia found that a significant number of tension pneumothoraces were missed prior to assessment at the hospital4. This led to a change in the clinical guideline for paramedics resulting in a 60% decrease in undiagnosed tension pneumothorax within the next 12months4. There has been no Australian study to establish the incidence of pneumothorax or its specific clinical predictors in MVA survivors. This could be a useful tool for doctors during assessment of chest injured MVA patients therefore the need for this study OBJECTIVES Pneumothorax (PTX) is a treatable yet potentially fatal surgical condition. Clinical diagnosis of this condition can be very unreliable. A review of medical records over a 5 year period was done with the aim of identifying common predictors of pneumothorax as well as defining the common forms of chest injuries associated with it in motor vehicle accident (MVA) survivors by embarking on a critical analysis of data collected from the study. MATERIALS AND METHODS A retrospective chart review was carried out on a total of 63 male and female patients of all age groups with chest injuries specifically resulting from motor vehicle accidents. A comparative analysis of data was carried out on these patients after categorising them based on age, sex, position of the victim at the time of occurrence of MVA, nature of the injury (blunt/penetrating), association with subcutaneous emphysema, rib fractures and intrathoracic organs RESULTS In this study, out of the 63 cases reviewed, there was a total of 18 cases of pneumothorax: 14 males (77.78%) and 4 females (22.22%) with an age range between 7 to 70years, a median age of 38.5years and average age of 41.44years. 7 of these patients were motorcyclists, 6 drivers, 2 bicycle riders, 2 pedestrians, 1 motorcycle passenger and all patients survived with no case fatality recorded. 88.89% resulted from blunt chest injuries while 11.11% resulted from penetrating chest injuries. All the penetrating chest injuries were associated with pneumothorax. 50% of pneumothoraces had an associated fracture of multiple ribs, 27.78% had an associated fracture of a single rib and 38.89% were associated with subcutaneous emphysema, 66.67% of pneumothorax had tube thoracostomy while 33.33% were conservatively managed by hospital admission and observation. CONCLUSION Pneumothorax occurs in 28% of MVA survivors with chest injuries with about three quarters of these cases (72.2%) accounted for by motorcyclists and vehicle drivers. Other strong predictors for pneumothorax are the presence of penetrating chest injury and fracture of one or more ribs. When diagnosed and appropriately managed, 100% survival from pneumothorax is achievable. Evidence was found in support of routine imaging investigation of MVA victims with chest injuries as clinical diagnosis of pneumothorax was insensitive. Also, either surgical intervention with tube thoracostomy or hospital admission for clinical monitoring should be routinely carried out on these patients.