Sumish Suresh, Yengkhom Singha, Samuel Tokbi
Thoracic trauma is a major contributor to trauma-related mortality, often presenting catastrophic internal injuries with minimal external markers. This retrospective autopsy-based investigation analyzes the socio-demographic profile, pathophysiological mechanisms, and lethal outcomes of fatal thoracic trauma in southern Assam between 2024 and 2025. Conducted at Silchar Medical College and Hospital, the study evaluated 70 fatalities using detailed medicolegal autopsies, police inquests, and clinical records. The cohort demonstrated a marked vulnerability among young adult males (78.6%), with a mean age of 34.66 years. The predominant mechanism of injury was road traffic accidents (74.3%), driven overwhelmingly by blunt force (88.6%). Alcohol consumption was a prevalent behavioral risk factor (45.7%). Survival dynamics revealed extreme immediate lethality, with 48.6% of victims dying instantaneously at the scene and a median survival time of just one hour. Distinct biomechanical injury patterns emerged: blunt trauma was overwhelmingly associated with lung contusions (71.0%, p < 0.001), while penetrating trauma significantly correlated with lung lacerations (62.5%, p = 0.023). Massive hemothorax was identified in 48.6% of cases, culminating directly in hemorrhagic shock, which formed the leading cause of death (57.1%), followed by traumatic coma (28.6%). The findings underscore that thoracic trauma fatalities in this region are fundamentally driven by high-velocity blunt forces from vehicular collisions. The profound pre-hospital mortality rate highlights the immediate lethality of intrathoracic hemorrhage, necessitating urgent improvements in early trauma resuscitation, advanced pre-hospital care, and road safety infrastructure