[Diagnosis and immediate therapeutic management of chest trauma. A systematic review of the literature]

Injuries to the chest contribute significantly to the morbidity and mortality in multiple injured patients. This systematic review focuses on evidence based initial diagnostics and emergency room management of chest trauma.Clinical trials was systematically collected (Medline, Cochrane and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system).There are only a few studies that document the impact of injury mechanism and clinical examination of the patient. There is a positive correlation between crash severity or lateral impact with injury severity. Auscultation was found to be very sensitive in the detection of pneumothorax. Helical CT of the chest is most important in the initial work-up. Aortography is only indicated in selected cases. Whether tube thoracostomy is necessary in patients with occult pneumotharaces is still a matter of discussion. Indications for endotracheal intubation are poorly investigated and predominantly based on expert opinion.Numerous comparative studies (LE 2) dealing with emergency diagnostics and therapy of chest trauma are available, however only a few randomized studies do exist. Based on the available data a rational therapy of chest trauma is possible.