title: Chest injuries associated with head injury.
abstract: BACKGROUND
  Although there have been significant advances in the management of traumatic brain injury (TBI), associated severe injuries, in particular chest injuries, remain a major challenge. This paper analyses the contribution of chest injuries to the outcome of head injuries in the University of Nigeria Teaching Hospital (UNTH) and the Memfys Hospital for Neurosurgery (MHN) in Enugu, Nigeria.
  
  
  METHODS
  This is a retrospective review of the medical records, operative notes, and radiological findings of all patients admitted for head injury who had associated significant chest injuries in the MHN from 2002 to 2009 and the UNTH between 2007 and 2010. Patients with only head injury and other extracranial injury not affecting the chest were excluded. Patients who were inadequately investigated were also excluded.
  
  
  RESULTS
  Nineteen patients from the MHN and 11 patients from the UNTH were analyzed. Ages ranged from 9 to 65 years and the male:female ratio was 3:1. Injuries were most common between 30 and 50 years and road traffic accident accounted for 60%. Barotrauma from ventilation was documented in 2 patients. The commonest types of intrathoracic injuries are pneumothorax and hemothorax. Chest wall injuries are more common but carry less morbidity and mortality. Only 20% of patients presented within 48 hours of injury. Management of the associated chest trauma commenced in the referring hospitals only in 26.4% of the patients. All patients with hemo-pneumothorax had tube thoracostomy as did 96% of patients with pneumothorax. 10% of patients with haemothorax needed thoracotomy. Mortality is 43%, which is higher than for patients with only TBI with comparable Glasgow coma scale. Outcome is influenced by the time to admission and the GCS on admission.
  
  
  CONCLUSIONS
  Associated chest injuries result in higher mortality from head injuries. This association is more likely in the young and more productive. All patients presenting with head and spinal cord injury should be specifically and carefully evaluated for associated chest injuries. Computerized tomographic has not replaced the need for good quality chest radiograph in the emergency management of Head Injury associated chest trauma.
authors.affiliation: Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital ; Memfy's Hospital for Neurosurgery, Enugu, Nigeria.
authors.forename: Wilfred Chukwuemeka
authors.initials: WC
authors.lastname: Mezue
authors.forename: Chika A
authors.initials: CA
authors.lastname: Ndubuisi
authors.forename: Uwadiegwu A
authors.initials: UA
authors.lastname: Erechukwu
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Ohaegbulam
keywords: Chest injuries; head injuries; outcome
references.citation: BMJ. 2008 Feb 23;336(7641):425-9
references.pmid: 18270239
references.citation: Chest. 2003 Dec;124(6):2261-6
references.pmid: 14665509
references.citation: PLoS Med. 2008 Aug 5;5(8):e165; discussion e165
references.pmid: 18684008
references.citation: J Cardiothorac Surg. 2011 Jan 18;6:7
references.pmid: 21244706
references.citation: J Trauma. 1995 Dec;39(6):1081-6
references.pmid: 7500398
references.citation: East Afr Med J. 1990 Jun;67(6):447-51
references.pmid: 2279476
references.citation: J Trauma. 2003 Jul;55(1):106-11
references.pmid: 12855888
references.citation: J Neurosci Rural Pract. 2010 Jan;1(1):2-8
references.pmid: 21799609
references.citation: J Neurosurg. 1992 Dec;77(6):901-7
references.pmid: 1432133
references.citation: Ann R Coll Surg Engl. 1981 Mar;63(2):102-4
references.pmid: 7247266
references.citation: Neuroepidemiology. 2009;32(2):136-41
references.pmid: 19088486
references.citation: Crit Care Med. 2010 Jul;38(7):1562-8
references.pmid: 20526198
references.citation: Afr J Med Med Sci. 2008 Sep;37(3):293-302
references.pmid: 18982825
references.citation: J Trauma. 2009 Apr;66(4):1212-7
references.pmid: 19359940
references.citation: J Neurosurg Anesthesiol. 1994 Jan;6(1):4-14
references.pmid: 8298263
references.citation: Acta Neurochir (Wien). 1990;103(3-4):109-11
references.pmid: 2399836
references.citation: J Trauma. 2007 Apr;62(4):946-50
references.pmid: 17426553
references.citation: J Trauma. 1997 May;42(5):773-7
references.pmid: 9191654
references.citation: Acta Neurochir Suppl (Wien). 1993;59:98-101
references.pmid: 8310869
references.citation: Acta Anaesthesiol Scand. 1991 Feb;35(2):148-52
references.pmid: 2024564
references.citation: J Trauma. 1990 Dec;30(12):1460-8
references.pmid: 2258956
references.citation: Crit Care Med. 1998 Feb;26(2):344-51
references.pmid: 9468174
references.citation: S Afr J Surg. 2010 Jul 13;48(3):90-3
references.pmid: 21924001