Prevalence and Factors Associated with Mortality among Chest Injury Patients Admitted at Muhimbili National Hospital in Dar es Salaam, Tanzania

Introduction: Accidents represent a significant proportional of non-communicable disease in the current century, and chest injury is common. However, management and outcome of these injuries is poor in low resource setting like Tanzania. The aim of this study was to determine the prevalence and factors associated with mortality among chest injury patients at a tertiary level health facility in Tanzania. Method: A prospective Cross-Sectional study of chest injuries among trauma patients attended at Muhimbili National Hospital between September 2019 and February 2020. Results: A total of 282 trauma patients were seen, out of which 51/282 (18.1%) sustained chest injury. Road Traffic Crashes were the leading cause of chest injury 41/51 (80.4%). Majority 17/51 (33.3%) presented with lung contusion, followed by pneumohemothorax and rib fractures each 8/51 (15.7%). Most of the patients 27/51 (52.9%) were managed by tube thoracostomy and 42.1% conservatively. Mortality was 11/51 (21.6%). Independent factors associated with mortality were: Associated injuries (Odds Ratio (OR) 0.07, 95% CI 0.01 - 1.16, p = 0.02), Multimodal analgesia (Odds Ratio (OR) 0.22, 95% CI 0.05 - 0.98, p = 0.05), more than 24 hours to treatment (Odds Ratio (OR) 5.53, 95% CI 1.25 - 24.3, p = 0.02), Bilateral chest involvement (Odds Ratio (OR) 4.61, 95% CI 1.12 - 18.7, p = 0.02), and Invasive ventilation (Odds Ratio (OR) 31.5, 95% CI 4.47 - 53.8, p = 0.00). Conclusion: Chest injuries prevail significantly among trauma patients in Tanzania, mostly due to road traffic crashes. Injury preventive measures especially for road traffic crashes need to be reinforced, and establishment of chest injury management protocol in Tanzania.

Surgical Management of Herniated Intrathoracic Gastric Perforation in Traumatic Diaphragmatic Rupture: An Unusual Two Rare Cases

Gastric perforation into the thoracic cavity through a diaphragmatic rupture is rare but, when it occurs, patients present in severe distress, with mortality approaching 50%. We present our experience of two rare and unusual cases of traumatic diaphragmatic rupture from penetrating chest injury associated with herniated intrathoracic gastric perforation over a five-year period from January 2015 to December 2020 at the cardiovascular and thoracic surgery department of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Both patients underwent successful surgical repair through standard posterolateral thoracotomy with one having earlier negative exploratory laparotomy. The essence of the paper is to share and discuss the clinical presentation, diagnostic challenges, surgical management and the postoperative care of this very rare complication of traumatic diaphragmatic rupture.

Subclavian Artery Pseudoaneurysm following Stab Injury and Its Surgical Approach: A Case Report and Literature Review

Penetrating injuries to the subclavian arteries as well as post traumatic pseudoaneurysm involving Subclavian artery (SCA) are very much uncommon. We present one case of a 21 year-old male sustained a physical assault with a post stab injury left subclavian artery pseudoaneurysm. He was referred to our facility, two days after sustaining a penetrating chest trauma over left infraclavicular area of the chest. The presentation, diagnostic procedures and surgical approach for management of this very rare injury are discussed.