Indications for Early Thoracotomy in the Management of Chest Trauma

Kish, George; Kozloff, Louis; Joseph, William L.; Adkins, Paul C.

doi:10.1016/s0003-4975(10)63946-x

Cited by 95 publications

(31 citation statements)

References 10 publications

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“…However, worldwide there is no clear consensus on indications for thoracotomy in penetrating chest injury. Some studies conclude that initial chest tube outcome is not a determining factor for the level of total blood loss and therefore surgical intervention in cases of lower volume loss, such as more than 800 cc is necessary [11,12].…”

Section: Discussionmentioning

confidence: 99%

Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands

Heus

Mellema

Giannakópoulos

et al. 2015

Eur J Trauma Emerg Surg

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Section: Discussionmentioning

confidence: 99%

Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands

Heus

Mellema

Giannakópoulos

et al. 2015

Eur J Trauma Emerg Surg

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“…Thoracic surgeons generally agree that most patients with penetrating wounds of the chest can be managed successfully without operation [2][3][4][5][6][11][12][13][14][15]. The proportion of those who can be treated without operation has been reported to vary from 62.1% to 91.4% [2][3][4][5][6]13].…”

Section: Discussionmentioning

confidence: 99%

Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

et al. 1998

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Penetrating chest injuries are a challenge to the thoracic or trauma surgeon. Penetrating thoracic trauma, especially that due to high-velocity gunshot wounds, is increasing at an alarming rate in our region. We report our experience with penetrating chest injuries mainly due to high-velocity gunshot wounds. During a period of 6 years we retrospectively reviewed the hospital records of 755 patients admitted to the Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, with the diagnosis of penetrating thoracic trauma. The mean age was 27.48 years, and 89-8% were male. The causes of penetrating injury were stab wounds in 45.3% and gunshot wounds in 54.7%. About 30% of the wounds were due to high-velocity gunshots; and among the gunshot wounds 56.2% were due to high-velocity shots. The most common thoracic injury was hemothorax (n = 190) followed by hemopneumothorax (n = 184). Isolated thoracic injuries were found in 53% of the patients. Nonoperative management was sufficient in 92% of the patients. Thoracotomy was performed in 8.1%. The mean duration of hospitalization was 11.2 days. The mean injury severity score (ISS) was 20.17 +/- 13.87. The morbidity was 23.3% and the mortality 5.6%. Fifty percent of all deaths were due to adult respiratory distress syndrome. Altogether 17% of patients with an ISS > 25 died, whereas only 0.9% of those with a score < 16 died. The mortality due to firearms was 8.95%. We concluded that in civilian practice chest tube thoracostomy remains by far the most common method of treating penetrating injury to the chest. The easy availability of high-velocity guns will continue to increase the number of civilians injured by these weapons.

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“…1,3,6,[8][9][10] Outcomes after blunt injury are significantly worse, predominately due to extrathoracic injuries. 5,6,9 In addition, there is a tendency to greater delay in performing surgical intervention after blunt compared with penetrating chest trauma.…”

Section: Commentmentioning

confidence: 99%

Timing of Urgent Thoracotomy for Hemorrhage After Trauma

et al. 2001

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It is possible to quantify an amount of thoracic hemorrhage, after blunt and penetrating injury, at which delay of thoracotomy is associated with increased mortality.Design: A retrospective case series.Setting: Five urban trauma centers.Study Selection: Patients undergoing urgent thoracotomy (within 48 hours of injury) for hemorrhage (excluding emergency department thoracotomy). Data Extraction:Respective registries identified patients who underwent urgent thoracotomy. Injury characteristics, initial and subsequent chest tube outputs, time before thoracotomy, and outcomes were evaluated.Main Outcome Measure: Death.Results: One hundred fifty-seven patients (36 with blunt and 121 with penetrating injuries) underwent urgent thoracotomy for hemorrhage between January 1, 1995, and December 31, 1998. Mortality correlated with mean (± SD) Injury Severity Score (38±19 vs 22±12.6 for survivors; PϽ.01) and mechanism (24 [67%] for blunt vs 21 [17%] for penetrating injuries; PϽ.01). Mortality increased as total chest blood loss increased, with the risk for death at blood loss of 1500 mL being 3 times greater than at 500 mL. Blunt-injured patients waited a significantly longer time to thoracotomy than penetratinginjured patients (4.4±9.0 h vs 1.6±3.0 h; P=.02) and also had a greater total chest tube output before thoracotomy (2220±1235 mL vs 1438±747 mL; P =.001). Conclusions:The risk for death increases linearly with total chest hemorrhage after thoracic injury. Thoracotomy is indicated when total chest tube output exceeds 1500 mL within 24 hours, regardless of injury mechanism.

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Indications for Early Thoracotomy in the Management of Chest Trauma

Cited by 95 publications

References 10 publications

Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands

Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands

Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

Timing of Urgent Thoracotomy for Hemorrhage After Trauma

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