Analysis of Outcome Between Isolated Flail Chest and Flail Chest with Polytrauma in a Busy Tertiary Care Centre
DOI:
https://doi.org/10.61919/6anr4r42Keywords:
Flail chest, polytrauma, pulmonary contusion, mechanical ventilation, blunt chest trauma, respiratory failure, tube thoracostomyAbstract
Background: Flail chest is a severe manifestation of blunt chest trauma (BCT) often accompanied by pulmonary contusion and respiratory compromise. Outcomes vary depending on whether the injury occurs in isolation or as part of polytrauma, significantly influencing morbidity and mortality. Objective: To compare the outcomes of isolated flail chest (Group A) and flail chest associated with polytrauma (Group B) in terms of morbidity and mortality following blunt chest trauma. Methods: This prospective cohort study was conducted in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from November 2022 to November 2023. Patients aged ≥12 years presenting with flail chest after blunt trauma were enrolled. Demographic, clinical, and radiological parameters were recorded. Data were analyzed using SPSS version 23. Associations between categorical variables were evaluated with the chi-square test, with p < 0.05 considered statistically significant. Results: Eighty-six patients met the inclusion criteria, including 66 (76.7%) males, with a mean age of 43.6 ± 14.1 years. Thirty (34.9%) had isolated flail chest and 56 (65.1%) had flail chest with polytrauma. Road traffic accidents were the predominant cause (72; 83.7%). Pulmonary contusion occurred in 65 (75.5%) patients. Tube thoracostomy and intravenous analgesia were performed in 80 (93.0%) and 75 (87.2%) patients, respectively, while 41 (47.7%) required mechanical ventilation. Respiratory failure and ARDS were significantly associated with mechanical ventilation and mortality (p < 0.001). The extent of rib fractures correlated with prolonged hospital stay (p = 0.001), pulmonary contusion (p = 0.007), and pneumonia (p = 0.003). In polytrauma cases, head and cardiac injuries were strongly associated with increased mortality and respiratory complications (p < 0.001). Conclusion: Flail chest, particularly when accompanied by polytrauma, is associated with higher morbidity and mortality. Isolated flail chest cases generally show better outcomes, underscoring the importance of early diagnosis, vigilant monitoring, and multidisciplinary management.
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Copyright (c) 2025 Shifa Naz, Rafia Zafar, Tanveer Ahmad, Misauq Mazcuri, Ambreen Abid, Nazish Sikandar (Author)
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