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INTRODUCTION Chest trauma is a common surgical incidence all over the world. Chest Trauma scoring system (CTS) is found in many studies to be an effective tool to predict outcomes in chest trauma patients. The need for a universal system for thoracic trauma is justified to identify critical factors, to predict patient outcomes, urgent need for intervention, and requirement of intensive care and to communicate with the family. Therefore there is a need of study and scoring system which can predict possible outcome. MATERIAL AND METHODS This is a prospective, longitudinal, observational study conducted at Universal College of Medical Sciences, Bhairahawa from October 2019 to March 2021. The chest trauma score was used to evaluate the outcome in patient admitted with blunt trauma chest. Duration of hospital stay, respiratory complications, need of ICU and Ventilators and mortality were noted as outcomes. RESULTS In this study, 79 cases with blunt trauma chest were admitted with road traffic accident being major factor for admission. Most patients were in age group 45-65 years of age with male predominance (84.8%). The results showed that patient with high CTS =5 was associated with higher incidence of pneumonia and need of ICU. The ROC curve showed that CTS predict significantly mortality with sensitivity of 100% and specificity of 92.2% with cutoff value of 7.5. Similarly, mean duration of hospital stay of patients having CTS =5 was 6.57 days more than patients having CTS <5. CONCLUSION Chest Trauma Score is a good predictor of outcome in patient with blunt chest trauma. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Road traffic injury is one of the fastest growing health problems in Nepal with increasing number every year leading to morbidity and mortality. Blunt pulmonary contusion may not be seen in the initial plain radiographs as they evolve over 12-24 hours. Thus CT (Computed Tomography) scan can provide detailed information about the contusion and predict the need for mechanical ventilation. MATERIAL AND METHODS: This is a prospective, observational longitudinal study conducted at Universal College of Medical Sciences, Bhairahawa from 1st January 2020 to 31st December 2020. The predictors for requirement of mechanical ventilation like Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), GCS score and number of fractured ribs at the time of admission were recorded. RESULTS: In this study, 100 cases with blunt pulmonary contusion were evaluated. Average age of patients with blunt pulmonary contusion was around 39.10±17.56 years with male predominance (82%). Total of 7 patients required mechanical ventilation among whom the AIS chest was 3.0±0.82, ISS score was 29.14±6.89, and GCS 9.14±3.13. The ROC curve showed that ISS score predicted significantly about the requirement of mechanical ventilation with sensitivity of 85.5% and specificity of 99.8 %. CONCLUSION: Initial CT done in patients can show the presence or absence of pulmonary contusion and associated thoracic injuries and along with AIS, ISS and GCS scores we can predict early the requirement of mechanical ventilation. [ABSTRACT FROM AUTHOR]

Epidemiologic data regarding health care acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) from Nepal are negligible. We conducted a prospective observational cohort study in the intensive care unit (ICU) of a major tertiary hospital in Nepal between April 2016 and March 2018, to calculate the incidence of VAP, and to describe clinical variables, microbiological etiology, and outcomes. Four hundred and thirty-eight patients were enrolled in the study. Demographic data, medical history, antimicrobial administration record, chest X-ray, biochemical, microbiological and haematological results, acute physiology and chronic health evaluation II score and the sequential organ failure assessment scores were recorded. Categorical variables were expressed as count and percentage and analyzed using the Fisher's exact test. Continuous variables were expressed as median and interquartile range and analyzed using Kruskal-Wallis rank sum test and the pairwise Wilcoxon rank—sum test. 46.8% (205/438) of the patients required intubation. Pneumonia was common in both intubated (94.14%; 193/205) and non-intubated (52.36%; 122/233) patients. Pneumonia developed among intubated patients in the ICU had longer days of stay in the ICU (median of 10, IQR 5–15, P< 0.001) when compared to non-intubated patients with pneumonia (median of 4, IQR 3–6, P< 0.001). The incidence rate of VAP was 20% (41/205) and incidence density was 16.45 cases per 1,000ventilator days. Mortality was significantly higher in patients with pneumonia requiring intubation (44.6%, 86/193) than patients with pneumonia not requiring intubation (10.7%, 13/122, p<0.001, Fisher's exact test). Gram negative bacteria such as Klebsiella and Acinetobacter species were the dominant organisms from both VAP and non-VAP categories. Multi-drug resistance was highly prevalent in bacterial isolates associated with VAP (90%; 99/110) and non-VAP categories (81.5%; 106/130). HAP including VAP remains to be the most prevalent hospital-acquired infections (HAIs) at Patan hospital. A local study of etiological agents and outcomes of HAP and VAP are required for setting more appropriate guidelines for management of such diseases. [ABSTRACT FROM AUTHOR]