Characteristics of Thoracic Trauma in The Enrique Cabrera Hospital. Review of A Five-Year Period

Chest injuries were first described around 1600 BC in the Edwin Smith Papyrus of Ancient Egypt. The writings of Hippocrates in the fifth century also contain a series of reports of trauma cases, including thoracic injuries. [1,2]. The surgical procedures of the thoracic conditions have evolved with the development of humanity since Hippocrates with its surprising operative techniques, Ambrosio Paré (1510-1570), one of the first to resort to the ligation of the great vessels Dominican Neo (S. XVIII) Initiator of the treatment of traumatic pneumothorax with the principle of aspiration. Johnione (1775), who described paracentesis as the last method that allows the effective exit of the accumulated air in the cavity, and so on until today [3]. In the nineteenth century, considerable progress was made in surgery with the modern drainage system under a water seal favored by mechanical artificial ventilation and the development of radiology that made possible the exploration of the pulmonary parenchyma and the improvement of thoracotomy [4].


Introduction
Chest injuries were first described around 1600 BC in the Edwin Smith Papyrus of Ancient Egypt. The writings of Hippocrates in the fifth century also contain a series of reports of trauma cases, including thoracic injuries. [1,2]. The surgical procedures of the thoracic conditions have evolved with the development of humanity since Hippocrates with its surprising operative techniques, Ambrosio Paré (1510-1570), one of the first to resort to the ligation of the great vessels Dominican Neo (S. XVIII) Initiator of the treatment of traumatic pneumothorax with the principle of aspiration. Johnione (1775), who described paracentesis as the last method that allows the effective exit of the accumulated air in the cavity, and so on until today [3]. In the nineteenth century, considerable progress was made in surgery with the modern drainage system under a water seal favored by mechanical artificial ventilation and the development of radiology that made possible the exploration of the pulmonary parenchyma and the improvement of thoracotomy [4].
In the last two decades, the management of thoracic trauma has progressed enormously especially Two to the development of diagnostic aids such as computed tomography, ultrasonography, magnetic resonance imaging and dynamic computed X-rays. In addition, advances in intensive care, emergency thoracotomy, video thoracoscopy, pain management and respiratory physiotherapy and the support of antibiotic therapy have influenced [5] Thoracic trauma constitutes a major public health problem and is the leading cause of death in people of productive ages in the world.
In the United States, it is the fourth leading cause of death after coronary heart disease, cancer and cerebrovascular diseases, and it is estimated that 25% of trauma deaths are the result of thoracic injuries and that these constitute half of the overall mortality Two Summary Introduction. Thoracic trauma is common in today's society and of great importance Two to the nature of the organs that are located inside the thorax. Goals. Describe the characteristics of the patients admitted with the diagnosis of thoracic trauma. Methods It was made a Descriptive, retrospective and qualitative quantitative study, in which 102 patients were admitted to Enrique Cabrera Hospital with the diagnosis of thoracic trauma in the period from January 1, 2014 to December 31, 2018. Data from the medical records of the admitted patients were obtained. Results: Male (77.45%) and ages between 40 and 49 years (25.49%) predominated in the study. Traffic accidents were the most frequent cause of trauma (31.38%), with predominantly thoracic trauma contused (63.73%). The thoracic lesion caused by the most frequent trauma was the pneumothorax (44.11%) and the most frequent extra thoracic lesions associated with the thoracic trauma occurred in the extremities (13.72%), no lesions were associated in 66.75% of the patients. The surgical treatment was the most used being the Minimum Pleurotomy the most used (73.72%). The most frequent complication was wound infections (13.72%), in 58.82%. of the patients there were No complications. 44.12% of the patients remained to trauma. In addition, it is estimated that for every person who This from trauma there are three injured, which translates into a great economic, moral and social cost [6][7][8].
In Cuba, accidents are among the leading causes of death, and chest traumas, often associated with accidents, represent 4 to 6% of hospital trauma revenues; its mortality is approximately 15% when lesions of internal organs of the thorax are present. [9,10] The traumatized patient may present with injuries at any level, however, the chest is of particular interest because it is a frequently damaged area Two to its location and anatomical extension, as well as the presence of organs that make these lesions always considered There may be an appointment of the musculoskeletal structures of the chest wall and / or intrathoracic organs by various production mechanisms: direct contusion, deceleration and shear mechanisms, or increased intrathoracic pressure. [11][12][13][14]. They usually occur as a result of car accidents, firearm projectile or shear puncture injuries, height drops or chest compression Two to crushing and usually of not need thoracotomy (80-85%), with Pleurostomy treatment and medical treatment being the most frequent. Isolated studies describe changes in the clinical characteristics and epidemiology of thoracic trauma over time [15][16][17]. All of the above has motivated the authors to carry out this study with the objective of determining the behavior of thoracic trauma in the population that attends the Enrique Cabrera Hospital, where there are no records in this regard, in order to collaborate in the prevention and rapid therapeutic management of these patients and reduce morbidity and mortality, preventable in this type of trauma.  was the one with the highest number, followed by age 50-59 (23.52%) and patients of the elderly 23 cases (22.55%). Table 2 shows that the male sex was more frequent in our study 79 patients (77.45%), the female sex was less 23 patients (

Am J Biomed Sci & Res
Copy@ Jorge Agustin Satorre Rocha  In Table 9. It is appreciated that in the patients the hospital stays prevailed from 5 to 10 days 45 cases (44.12%), followed in less than 5 days 40 cases (39.21%) and in more than 10 days 17 cases (16.67 %), of the total of 102 patients.

Discussion
Thoracic trauma classically occurs in young men with an average age less than 40 years explaining this because they are the most physically and economically active ages with the greatest social development [18]. In the present investigation the fourth produced by knife and firearms. [22][23][24].
The causes of penetrating or blunt trauma and its frequency vary mainly according to geographic location. In our case, traffic accidents predominated, followed by wounds caused by a knife with a frequency similar to falls in general. Similar results are reported in the United States and Europe, however in Latin America wounds Two to stab and firearms are more frequent. In a similar study conducted in the province of Cienfuegos, wounds caused by a knife were more frequent, followed by traffic accidents. [20,23,24] The injuries most caused by thoracic trauma were pneumothorax and rib fractures, which coincides with the literature consulted [19,22,25]. In a study conducted in Ecuador, hemothorax was the main diagnosis, followed by hemopneumothorax and pneumothorax; taking into account that the main cause was traffic accidents. [26]. In revised literatures, it is suggested that the pneumothorax is produced by the paper bag effect (pulmonary breaking when the glottis is closed before the shock) and are causes  [27,28].
In the majority of the authors reviewed, there was a predominance of isolated thoracic traumas over traumas with associated injuries and polytrauma, which coincides with our series, which implies a lower severity of the patients who are currently hospitalized for these traumas [23,[29][30][31]

Conclusions
The group of patients from 40 to 49 years of age was the most frequent, with the male sex being the most frequent. The type of blunt trauma was the most frequent and traffic accidents the most frequent cause of trauma. The pneumothorax was the most diagnosed lesion at admission. Lesions in the extremities and abdomen were the most associated with thoracic trauma.
The majority of patients had No associated lesions. The Minimum Pleurostomy was the most commonly used therapeutic procedure.
Uncomplicated patients predominated and the most frequent complication was wound infections. Patients with a hospital stay of 5 to 10 days were the most reported.

Conflicts of Interest
There are no conflicts of interest.