Dr. Yasith Mathangasinghe

Chest trauma contributes to a high morbidity and mortality worldwide. Prompt diagnosis and timely treatment are major determinants of the clinical outcome of thoracic injuries. The awareness of injury patterns is imperative for making a prompt diagnosis. Despite recent advancements in therapeutic trauma care in Sri Lanka, the knowledge on thoracic injury patterns and treatment outcome remains sparse. Hence, we intended to explore the demographic patterns, clinical features and outcomes of chest trauma in Sri Lanka.
We conducted a multi-centre prospective cohort study in five leading teaching hospitals from different demographic regions of the country. We assessed the patients admitted to these hospitals with chest trauma over a period of one year, and followed them up to detect short-term clinical complications. We found that the automobile accidents, falls and assaults contributed to the majority of chest trauma in the study population. The commonest injury pattern was rib fractures. Male gender and automobile accidents were associated with poor clinical outcomes. The majority of the study population underwent operative management. The mean hospital stay was 15.6 days, which was considerably longer compared to the Western countries, probably because the patients were unable to afford the rib fixatives which were not provided by the government free of charge. Moreover, pain management was mainly restricted to enteral and intramuscular analgesia while multimodal analgesia (inclusive of epidural analgesia) are increasingly being utilized in the developed countries. We also noted that objective scales to assess the global severity of trauma are rarely being used in the management of patients with thoracic trauma in our country.
These findings highlight the need to develop and implement national guidelines for chest trauma management in Sri Lanka.