Overview
Superficial chest wall injuries with infection involve trauma to the chest wall that may extend to involve soft tissue infections, often complicating rib fractures or penetrating wounds. These injuries can lead to significant morbidity and require careful management to prevent complications such as respiratory failure and systemic infection.Diagnosis
Clinical Presentation: Pain, tenderness, localized swelling, and signs of systemic infection (fever, leukocytosis) 1.
Imaging: Chest X-ray and CT scans to assess extent of injury and presence of complications 1.
Laboratory Tests: Complete blood count, C-reactive protein, and blood cultures to evaluate infection 1.
Prognostic Indices: Glasgow Coma Scale and Injury Severity Score useful for assessing outcomes 3.Management
Analgesia: Use of ketamine, epidural analgesia, and locoregional nerve blocks for pain management in older adults 1.
Infection Control: Early identification and targeted antibiotic therapy based on culture results 1.
Supportive Care: Consideration of incentive spirometry to prevent atelectasis and respiratory complications 1.
Non-Invasive Ventilation: Use of noninvasive positive pressure ventilation (NIPPV) as needed for respiratory support 1.Special Populations
Elderly: Intensive care unit (ICU) admission not definitively superior for outcomes; focus on tailored analgesia and supportive care 1.
Comorbidities: Management strategies should account for coexisting injuries and systemic conditions impacting prognosis 3.Key Recommendations
Tailor analgesia strategies including ketamine and regional blocks for older adults with chest wall injuries to improve pain management (Evidence: Moderate 1).
Consider non-surgical management with close monitoring for infection and respiratory complications, avoiding routine ICU admission unless indicated (Evidence: Moderate 1).
Utilize incentive spirometry and consider NIPPV to prevent respiratory complications in patients with chest wall injuries (Evidence: Moderate 1).References
1 Mukherjee K, Schubl SD, Tominaga G, Cantrell S, Kim B, Haines KL et al.. Non-surgical management and analgesia strategies for older adults with multiple rib fractures: A systematic review, meta-analysis, and joint practice management guideline from the Eastern Association for the Surgery of Trauma and the Chest Wall Injury Society. The journal of trauma and acute care surgery 2023. link
2 Jiang M, Li C, Yi C, Tang S. Early intramedullary nailing of femoral shaft fracture on outcomes in patients with severe chest injury: A meta-analysis. Scientific reports 2016. link
3 Schulpen TM, Doesburg WH, Lemmens WA, Gerritsen SM. Epidemiology and prognostic signs of chest injury patients. Injury 1986. link90151-8)