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Pulmonary injuries include a wide variety of clinical conditions. Most patients with blunt chest trauma can be managed with conservative treatment. Only about 10 to 15% of patients with severe chest injuries require major thoracotomy. Management of pulmonary contusion, pulmonary laceration, pneumothorax or hemothorax by oxygen inhalation, respirator assist and chest drainage can usually result in complete recovery. However, pulmonary injuries sometimes lapse into fatal condition if they are improperly treated. Open thoracotomy is required in cases with persistent massive air leakage or massive bleeding with the use of chest drainage. It is crucial to evaluate the extent and severity of the injuries based on chest X-ray and computed tomography (CT) findings for the proper initial treatment in patients with pulmonary injuries.

The study presented 596 cases with chest injuries, experienced for 4 years in our trauma and critical care center. Cases with chest injuries account for approximately 40% of all traumatized patients. Cases dead on arrival (DOA) show more significant frequency (87% of all traumatized DOA patients). To grasp the significance and the severity of chest injuries, we designed a new classification by the site where abnormality exists; 1) the chest wall, 2) the pleural cavity, 3) the airway, 4) the mediastinum, 5) the intrapericardial space, and 6) cardiac function. An application of the classification may clearly identify the initial direction for the treatment of chest injuries, including some examination which should be given priority. It is also suspected that a more exact decision making should be possible by an utilization of the classification.