Thoracic trauma – colloquially called chest injury – (synonyms: open thoracic trauma; blunt thoracic trauma; thoracic injury; thoracic injury; ICD-10 S29.9: Thoracic trauma) is the injury/wound (trauma) to the chest (thorax) caused by a mechanical force. Frequently, the organs or functional units located in the thorax, e.g., lungs, heart, blood vessels, esophagus, trachea, are also affected. Central problems of thoracic trauma are mainly hypoxia (lack of oxygen) and hypovolemia (lack of volume). They can quickly lead to death.
Around 15% of all accidental injuries are injuries to the thorax. In most cases, a thoracic trauma occurs as a concomitant injury of a polytrauma (multiple injury). In this case, the mortality rate (number of deaths in a given period, based on the number of the population in question) doubles. In polytrauma, combined injuries to the skull and extremities occur most frequently, followed by thorax and extremities, thorax and skull, thorax and abdomen (abdominal cavity). Thoracic trauma is the second leading cause of death in polytrauma patients after traumatic brain injury (TBI).Isolated thoracic traumas (injuries to the thorax (chest) without associated injuries) are rare (5%).
According to the cause, thoracic trauma is differentiated as follows:
- Blunt thoracic trauma (without bony involvement) – caused by impact or collision (e.g., traffic or work accidents; ski collision); approximately 90% of cases; approximately 30% of these patients show increased mortality
- Thoracic contusion (Commotio thoraci) – without bony involvement.
- Thoracic contusion (contusio thoracis) – involvement of intrathoracic organs (organs located in the thoracic cavity).
- Open (penetrating/into the chest wall) thoracic trauma – due to stabbing, gunshot or impalement injuries; about 10% of cases.
In the context of a thoracic trauma, injuries to the thorax, the mediastinum (“middle pleural space”/space between the lung wings) and the lungs can occur (for more information, see “sequelae”).
Sex ratio: Men are more frequently affected than women.
Frequency peak: The age peak of a thorax trauma is in the 3rd decade of life.
Thoracic trauma accounts for 10-15% of all accidental hospital admissions.
Course and prognosis: A thorax trauma is an emergency situation. Approximately 25% of all fatal accident victims die from thoracic injuries. Often, no external injury to the thorax is found at first glance. Nevertheless, severe intrathoracic (located within the thoracic cavity) injuries may be present. In 70% of cases, the injury is not to the thorax alone, so polytrauma must always be considered. In order to assess the nature and extent of a thoracic trauma, it is enormously important to reconstruct the course of the accident.In young accident victims, most of the kinetic energy is transmitted internally. Lung contusions (pulmonary contusions) are a common consequence. Older people have a much less elastic thorax (chest), so bony injuries are more likely to occur here.
The lethality (mortality related to the total number of people suffering from the disease) is up to 9.4 % and results from the severe concomitant diseases: Aorta 15.6%, visceral (affecting the vessels) 12.5%, heart 12.5%, pelvis 10.9%, skull 10.2%. For penetrating cardiac injuries caused by stab and gunshot wounds, mortality ranges from 35 to 82%.
