# Impact of Imaging on Surgical Management of Penetrating Chest Trauma: Experience From a High-Volume Trauma Center in a Resource-Constrained Environment

## TL;DR

This study shows that CT imaging helps surgeons manage chest injuries caused by penetrating trauma, even in areas with limited medical resources.

## Contribution

The study demonstrates the diagnostic and management value of non-contrast CT imaging for penetrating chest trauma in a resource-constrained setting.

## Key findings

- CT imaging identified critical injuries like pneumothorax, hemothorax, and lung damage in most patients.
- Non-contrast CT scans provided essential diagnostic information that influenced surgical decisions.
- Tube thoracostomy was the most common treatment, followed by conservative and open thoracotomy approaches.

## Abstract

Background

Penetrating chest trauma is a significant cause of morbidity and mortality, with the need for accurate and timely diagnosis being crucial in determining appropriate management. This study aims to evaluate the role of computed tomography (CT) imaging in the assessment and surgical management of patients with penetrating chest trauma at a high-volume trauma center in a developing country.

Objective

To assess the contribution of CT imaging in the evaluation and surgical management of patients presenting with penetrating chest trauma at a resource-limited trauma center in Pakistan.

Methods

A cross-sectional observational study was conducted in the Thoracic Surgery and Radiology Departments of Lady Reading Hospital, Peshawar, from January 2024 to June 2024. A convenient sampling technique was used to include 139 patients with penetrating chest trauma. Demographic details, trauma complications, fractures, and management strategies were recorded. Thick-slice, non-contrast, chest CT scans were performed and reviewed by a consultant radiologist. Data analysis was carried out using SPSS version 26 (IBM Corp., Armonk, NY).

Results

The study included 139 patients with a mean age of 26.7 ± 8.2 years (range: 8-70 years). The majority were male (126, 90.6%), and the most common mode of injury was firearm trauma (83, 59.7%). The most frequently observed complications were pneumothorax (110, 79.1%), hemothorax (112, 80.6%), and lung injury (88, 63.3%). Fractures were noted in 54 (38.8%) patients, with rib fractures being the most common (31, 22.3%). The most common management approach was tube thoracostomy (116, 83.5%), followed by conservative management (10, 7.2%) and open thoracotomy (6, 4.3%).

Conclusion

CT imaging is an invaluable tool in the assessment of penetrating chest trauma, aiding in the identification of hidden injuries and influencing surgical management decisions. Although thin-slice contrast-enhanced CT is the standard protocol in our resource-constrained setting, non-contrast axial CT scans offer critical diagnostic information and guide timely management. Its use significantly improves patient outcomes, especially in a resource-limited setting.