Chest Trauma Outcomes: Public Versus Private Level I Trauma Centers

Abstract

Background The goal of our study was to evaluate the differences in care and clinical outcomes of patients with chest trauma between two hospitals, including one public trauma center (Pu-TC) and one private trauma center (Pri-TC). Methods Patients with thoracic trauma admitted from January 2012 to December 2018 at two level I trauma centers (Pu-TC: Hospital Universitario del Valle, Pri-TC: Fundacio ´n Valle del Lili) in Cali, Colombia, were included. Multivariable logistic regression was used to assess for differences in in-hospital mortality, adjusting for relevant demographic and clinical characteristics. Results A total of 482 patients were identified; 300 (62.2%) at the Pri-TC and 182 (37.8%) at the Pu-TC. Median age was 27 years (IQR 21-36) and median Injury Severity Score was 25 . 456 patients (94.6%) were male, and the majority had penetrating trauma [total 465 (96.5%); Pri-TC 287 (95.7%), Pu-TC 179 (98.4%), p 0.08]. All patients arrived at the emergency room with unstable hemodynamics. There were no statistically significant differences in post-operative complications, including retained hemothorax [Pri-TC 19 vs. Pu-TC 18], pneumonia [Pri-TC 14 vs. Pu-TC 14], empyema [Pri-TC 13 vs. Pu-TC 13] and mediastinitis [Pri-TC 6 vs. Pu-TC 2]. Logistic regression did, however, show a higher odds of mortality when patients were treated at the Pu-TC , p \ 0.001]. Conclusions Our study found significant statistical differences in clinical outcomes between patients treated at a Pu-TC and Pri-TC. The results are intended to stimulate discussions to better understand reasons for outcome variability and ways to reduce it.

Damage control surgery in lung trauma

“…La mayoría de los casos de trauma torácico se resuelven con procedimientos sencillos y solamente una proporción pequeña llega a necesitar una toracotomía. Históricamente, la proporción de pacientes con requerimiento de toracotomía ha fluctuado entre el 15% y 25%, siendo mayor cuando es producto de un trauma penetrante 9 - 12 .…”

“…Vargo y Battistella 13 de Sacramento-Estado Unidos, y García et al 14 , de Cali-Colombia reportaron experiencias previas al 2015 una tasa menor del 6% de pacientes con toracotomía que hayan sido sometidos a cirugía de control de daños. Sin embargo, estos mismos grupos han reportado con su experiencia de los últimos 5 años una proporción del 22% y 21%, respectivamente 12 , 15 . Chica et al, reporto que el 42% de pacientes que tuvieron recuperación espontanea de la circulación después de una toracotomía de emergencias, fueron manejados con cirugía de control de daños 16 .…”

“…Se realiza una incisión en el cuarto o quinto espacio intercostal hasta línea axilar media. Si se necesita una mejor exposición de las estructuras torácicas se puede realizar una extensión de la incisión quirúrgica hacia el lado contralateral del tórax, tipo Clamshell 12 , 14 , 17 .…”

Hemodynamically unstable non-compressible penetrating torso trauma: a practical surgical approach

“…Penetrating torso trauma is the second leading cause of death following head injury 1 , 2 . Traffic accidents, falls and overall blunt trauma are the most common mechanism of injuries in developed countries; whereas, penetrating trauma which includes gunshot and stabs wounds is more prevalent in developing countries due to ongoing violence and social unrest 3 , 4 .…”

“…El trauma penetrante del torso representa la segunda causa de muerte de origen traumático después del trauma craneoencefálico. En países desarrollados existe mayor prevalencia de trauma cerrado, asociado principalmente a accidentes de tránsito o caídas de grandes alturas 1 , 2 . Mientas, que en países en vía de desarrollo el trauma penetrante es más prevalente con heridas por arma de fuego o por arma blanca asociado a la violencia y las desigualdades sociales 3 , 4 .…”