Objective   To analyze the epidemiological characteristics and clinical features of severe chest trauma (SCT) in Chongqing during different periods in order to improve severe chest trauma care outcome.   Methods   A total of 1 834 cases of severe chest trauma with AIS ≥ 3 and ISS ≥16 in Chongqing Emergency Medical Center from January 1990 to December 2009 were reviewed retrospectively. These patients were divided into 2 groups according to the treatment time (cases treated before 2000 and those after 2000)

and were divided into different groups according to their outcome (survival group and death group).   Results   Before and after 2000

blunt trauma covered 68.5% and 74.7% respectively (P0.01)

traffic injury covered 54.37% and 58.94% respectively (P=0.069)

and sharp instrument injury covered 12.21% and 15.9% (P0.05)

with statistical significances(P0.01

P0.05). After 2000

the pre-hospital time and transfers ratio had statistical significances (P0.01

0.05). Before and after 2000

there were statistical significances in thoracic AIS and RTS (P0.01). The after 2000 group had statistical higher in average numbers of heart and great vessels serious injury

of combined thoraco-abdominal wound and cerebral trauma compared with the group before 2000. The incidence rate of severe complications in the group after 2000 was 55.58% (314/565)

higher than that of the group before 2000 (673/1 269

53.03%) though without significant difference (P=0.338). The therapeutic effect to pulmonary infection and traumatic shock was significantly improved in the group after 2000 compared with that of the group before 2000 (P=0.019

P=0.008)

the mortality was decreased from 7.07% to 4.81% (P0.05)

and the hospitalization days was reduce though with no statistical significance (P=0.063). The most important cause of death was hypovolemic shock (59.41%)

followed by ARDS/respiratory failure (18.81%)

MODS(13.86%)

and primary brain trauma(7.92%). There was statistically difference in trauma score of the death group and the survival group (P0.01).   Conclusion   After 2000

the incidence of SCT is significantly increased

and becomes more serious

but therapeutic effects of serious complications is greatly improved.