Patterns, management and outcomes of chest trauma in a rural tertiary care hospital in North Kashmir: a prospective observational study

Mir Mushtaq Ahmad; Ishtiyaq Ahmad Ganaie; Mehmood Rashid Sheikh; Afak Yusuf Sherwani; Syed Mohsin Manzoor

doi:10.18203/2320-6012.ijrms20263505

Authors

Mir Mushtaq Ahmad Department of General & Minimal Access Surgery, Government Medical College, Baramulla, J & K, India
Ishtiyaq Ahmad Ganaie Department of General & Minimal Access Surgery, Government Medical College, Baramulla, J & K, India
Mehmood Rashid Sheikh Department of General & Minimal Access Surgery, Government Medical College, Baramulla, J & K, India
Afak Yusuf Sherwani Department of General & Minimal Access Surgery, Government Medical College, Baramulla, J & K, India
Syed Mohsin Manzoor Department of General & Minimal Access Surgery, Government Medical College, Baramulla, J & K, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263505

Keywords:

Chest trauma, Rural healthcare, North Kashmir, Blunt thoracic injury, Trauma management

Abstract

Background: Chest trauma remains a critical cause of morbidity and mortality, especially in rural and resource-limited settings. The heterogeneity in injury mechanisms and limitations in emergency infrastructure often pose major challenges in timely diagnosis and management. In North Kashmir, civilian trauma accounts for the majority of cases, while conflict-related injuries contribute a smaller but clinically relevant subset.

To analyze the clinical profile, modes of injury, types of chest injuries, management strategies and outcomes of patients presenting with chest trauma at a rural tertiary care hospital GMC Baramulla in North Kashmir over a five-year period.

Methods: This is a Prospective observational study of 430 patients presenting with chest trauma from July 2020 to July 2025 from GMC Baramulla. Data on demographics, type of trauma, injury patterns, treatment modalities, complications and hospital stay were analyzed using descriptive statistics and expressed as frequencies and percentages using standard statistical software.

Results: Blunt trauma accounted for 90.6% of cases, predominantly affecting males (74.4%). Road traffic accidents were the leading cause (46.5%), followed by falls (42.7%). Rib fractures and pulmonary contusions were the most common injuries. Most patients were managed conservatively (53.4%), while 30.2% required intercostal tube drainage and 15.8% underwent thoracotomy. Major morbidities included bronchopleural fistula (1.3%) and empyema (0.2%). More than half of the patients (58.1%) were discharged within five days.

Conclusions: In rural healthcare settings, structured protocols and timely interventions can effectively manage chest trauma with favorable outcomes. Strengthening trauma systems and referral pathways can further improve care delivery.

References

Baru A, Weldegiorgis E, Zewdu T, Hussien H. Characteristics and outcome of traumatic chest injury patients visited a specialized hospital in Addis Ababa, Ethiopia: A one-year retrospective study. Chin J Traumatol. 2020;23(3):139-44.

Choudhary A, Pasha MA, Pasha MA. A clinico-epidemiological study of traumatic chest injuries in a rural tertiary care centre in India: our experience. Int J Biomed Adv Res. 2015;6(02):110-4.

Narayanan R, Kumar S, Gupta A, Bansal VK, Sagar S, Singhal M, et al. An analysis of presentation, pattern and outcome of chest trauma patients at an urban level 1 trauma center. Indian J Surg. 2018;80(1):36-41.

Syed Amin T, Chowdary E, Kotwal N, Hamid S. Characteristics, outcomes and implications for care of firearm injuries during unrest in a conflict zone of india: a clinical retrospective study. J Trauma Treat. 2018;7(434):1-6.

Gupta AK, Sharma P, Sharma S. Epidemiological pattern of blunt trauma chest in Western India. Asian J Med Sci. 2020;11(2):1-5.

Iyer S, Singh M, Jathen V. Study of epidemiology and outcome of chest trauma at an apex-tertiary care trauma centre. Int Surg J. 2018;5:3621-6.

Anderson D, Chen SA, Godoy LA, Brown LM, Cooke DT. Comprehensive review of chest-tube management: a review. JAMA Surg. 2022;157(3):269–74.

Kesieme EB, Dongo A, Ezemba N, Irekpita E, Jebbin N, Kesieme C. Tube thoracostomy: complications and its management. Pulm Med. 2012;2012:2578.

McCrum ML, McKee J, Lai M, Staples J, Switzer N, Widder SL. ATLS adherence in the transfer of rural trauma patients to a level I facility. Injury. 2013;44(9):1241-5.

Douglas RJ, Vasanthi B, Giles AJA. Improving trauma care in India: a recommendation for the implementation of ATLS training for emergency department medical officers. Int J Emerg Med 3, 27–32 (2010).

Reddy NB, Hanumantha, Madithati P, Reddy NN, Reddy CS. An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study. J Emerg Trauma Shock. 2014;7(2):116-20.

Khursheed SQ, Ashraf W, Rather AA. Clinical profile and outcome of chest trauma: a four year retrospective analysis at a tertiary care centre. Int Surg J. 2019;6(7):2519–24.

Walia BS, Dugg P, Sharma S. Clinical features, management and outcomes of chest trauma at a tertiary-care centre in India: a retrospective observational study. Scientific World J. 2021;16:586.

Chen Q, Huang G, Li T, Zhang Q, He P, Yang J, et al. Insights into epidemiological trends of severe chest injuries: an analysis of age, period and cohort from 1990 to 2019 using the Global Burden of Disease study 2019. Scand J Trauma Resusc Emerg Med. 2024;32(1):89.

Kiragu AW, Dunlop SJ, Mwarumba N, Gidado S, Adesina A, Mwachiro M, et al. Pediatric trauma care in low resource settings: challenges, opportunities and solutions. Front Pediatr. 2018;4;6:155.

Hefny AF, Elkamhawy AA, Fathi SA, Zoubeidi T, Alshamsi F. Outcomes and predictors of mortality in patients with blunt chest trauma admitted to the intensive care unit: a retrospective study. Front Med (Lausanne). 2025;10;12:1633.

Nsengiyumva B, Henry MB, Kuntz HM, Estes MK, Randall MM, Guptill M. Chest trauma epidemiology and emergency department management in a tertiary teaching hospital in Kigali, Rwanda. Afr J Emerg Med. 2022;12(4):428-31.

Beshay M, Mertzlufft F, Kottkamp HW, Reymond M, Schmid RA, Branscheid D, et al. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World J Emerg Surg. 2020;31;15(1):45.

Zhang S, Xiao X, Wang J, Hu C, Du Q, Fu Z, et al. Epidemiological and clinical characteristics of road traffic crashes related thoracic traumas: analysis of 5095 hospitalized chest injury patients. J Cardiothorac Surg. 2021;16(1):220.

MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366-78.

Liang J, Field A, Liang K. Bronchopleural fistula. West J Emerg Med. 2013;14(5):409-10.

DuBose J, Inaba K, Okoye O, Demetriades D, Scalea T, O'Connor J, et al. AAST retained hemothorax study group. development of posttraumatic empyema in patients with retained hemothorax: results of a prospective, observational AAST study. J Trauma Acute Care Surg. 2012;73(3):752-7.

Walia BS, Dugg P, Sharma S. Clinical features, management and outcomes of chest trauma at a tertiary-care centre in India: a retrospective observational study. Sci World J. 2021;16:8052586.

Martin M, Schall CT, Anderson C. Results of a clinical practice algorithm for the management of thoracostomy tubes placed for traumatic mechanism. Springer Plus. 2013;2:642.

Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop. 2009;33(5):1425-33.

El-Menyar A, Abdelrahman H, Al-Hassani A, Ellabib M, Asim M, Zarour A, et al. Clinical presentation and time-based mortality in patients with chest injuries associated with road traffic accidents. Arch Trauma Res. 2016;5(1):31888.