This prospective cohort study from January 2004 to December 2011 included patients with blunt chest trauma. Patients with thoracic injuries were brought to the Kaohsiung Veterans General Hospital either by the emergency medical system (after an accident) or transferred from another hospital after primary management. Once admitted, patients were taken immediately to the trauma bay, surveyed by the trauma teams and managed according to Advanced Trauma Life Support (ATLS) guidelines. Resuscitation was initiated right away if the patients were identified as having unstable vital signs. Those with more stable vital signs underwent detailed medical history evaluations with complete physical examinations. CT-scan was routinely performed for further evaluation of any lesions found on chest X-ray. After the completion of primary treatment in the trauma bay, patients were admitted to the intensive care unit (ICU) for further care. A written informed consent was obtained from family members of each patient. This study was approved by the Institution Review Board of Kaohsiung Veterans General Hospital to review the medical record.