الفهرس 
Anatomy of the thoracic cavityOnly 14 pages are availabe for public view
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Abstract
Outcome and prognosis for a vast majority of patients with chest trauma are excellent. Most (>80%) require either non-invasive therapy or at most a thoracostomy tube. The most important determinant of outcome is the presence or absence of significant associated injuries . Early and accurate evaluation of the severity level in thoracic trauma is important for correct treatment, from predicting intensive care need, to future complications. Currently, there is no scale in general use that does this, thus We need for a precise scale in the evaluation of thoracic trauma. Scales such as the ISS (Injury Severity Score) or the TRISS (Trauma Injury Severity Score) are widely used, but these being global poly-trauma scales, they underestimate isolated thoracic trauma. Other scales specific to the thorax such as the Abbreviated Injury Scale (AISthorax) or Lung Injury Scale , rely solely on anatomical findings. Classically, it has been considered that the presence of 3 or more rib fractures or fracture of the first rib is associated with greater severity. The association of parameters such as age, mechanism and severity of injury with the development of pulmonary complications is still under study . In the year of 2000 , Pape et al described the Thorax Trauma Severity Score (TTSS) , a scale that included both anatomical and functional parameters. The purpose of the scale was to help emergency medical evaluation in identifying trauma patients at risk of pulmonary complications, using parameters available during the initial evaluation which could be applied in primary and secondary level hospitals . Our study was carried out upon 300 patients of traumatic chest injuries in Emergency Department of both Tanta University and Nasser Institute for research and treatment during the period of one year from 1 May 2018 to 30 April 2019 . The inclusion criteria was Adult patients above the age of 18 years old attending emergency department presenting with chest trauma . The exclusion criteria was Patient’s with burn , chronic respiratory disease that affects pulmonary functions , Pregnancy m Malignancy , End organ failure , Associated mediastinal injuries , Severe abdominal and pelvic injuries , Brain injuries with GCS below 13 . All patients were subjected to: Full history taking from the patient or his/her relatives or witness . According to ATLS, management consisted of a rapid primary survey, resuscitation of vital functions, a more detailed secondary survey, and, finally, the initiation of definitive care. Routine laboratory investigations were done : Random blood sugar , Complete blood picture , ABG . Routine radiological investigations were done : Chest-X-Ray , Chest Computed Topography , ECG , or Echocardiography to assess cardiac injury if suspected . Our study revealed that TTSS is a good prognostic tool combining anatomical and physiological parameters with respecting age parameter that has a good sensitivity and specifity for prognosis of isolated thoracic traumatic injuries , providing a simple reliable solution to the problem of early CT independent judgment of thoracic trauma . TTSS provides a simple tool that can be calculated easily , and can be applied in ER . In our study , low TTSS scores were associated with good prognosis ( discharge and inpatient ward admission ) . The high scores were associated with higher morbidity and mortality . Our study showed that TTSS score above or equal to 7 points has 100% sensitivity and 97.73 % specifity to morbidity (fair and poor prognosis) and mortality ( fatal prognosis ) of patients of isolated thoracic trauma patients with exclusion of associated severe extra thoracic injuries . Our study revealed that TTSS score of 7 or above is associated with developed ARDS and an increased rate of mechanical ventilation . In our study by using ROC curve we find area under the curve 0.998 that that shows that Thorax Trauma Severity Score is an excellent score . Our study revealed that , the majority of thoracic trauma injuries is managed by conservative treatment : pain control and physiotherapy , good resuscitation with oxygen , volume resuscitation , simple thoracostomy . Small number of cases need intubation and mechanical ventilation . Only very small percentage of patients underwent thoracotomy . Recently , the proper knowledge of the physiological mechanisms , the developed imaging systems , new therapeutics and minimally invasive procedures , all of those had contributed in decreasing the morbidity and mortality .