Emergency department thoracotomy following injury: Critical determinants for patient salvage

B. Timothy Baxter, Ernest E. Moore, John B. Moore, Henry C. Cleveland, Brian L. McCroskey, Frederick A. Moore

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

The role of emergency department (ED) thoracotomy in resuscitation of the moribund trauma patient remains ill-defined. The purpose of this article is to analyze our experience during the past decade in order to elucidate prognostic features enabling a more cost-effective application of this heroic measure. Injury mechanism in the 632 ED thoracotomies performed in our trauma consortium consisted of blunt (BLT) in 50%, gunshot wounds (GSW) in 35%, and stab wounds (SW) in 15%. Mean patient age was 31 years, and 76% were men. Twenty-nine (5%) of the patients were ultimately discharged alive from the hospital. Outcome was analyzed on the basis of physiologic status at presentation to the ED: group I, n=481 (76%), presented without signs of life (SL); group II, n=38 (6%), presented with SL (pupillary response), but without vital signs (VS); and group III, n=113 (18%), presented with VS. Survival without SL was 10% of SW, 1% of GSW, and 1% of BLT. When VS were present, patient salvage was 32% following SW, 15% following GSW, and 5% after blunt trauma. Five of 15 survivors without SL had irreversible cerebral damage; whereas, 13 of the 14 survivors with VS had no permanent neurologic sequelae. This experience underscores the rationale for selective application of ED thoracotomy done for postinjury resuscitation; functional salvage of the blunt trauma victim arriving lifeless is nil while nearly one-third of patients in extremis from a thoracic SW can be returned to their preinjury state.

Original languageEnglish (US)
Pages (from-to)671-674
Number of pages4
JournalWorld Journal of Surgery
Volume12
Issue number5
DOIs
StatePublished - Oct 1 1988

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Stab Wounds
Thoracotomy
Vital Signs
Hospital Emergency Service
Gunshot Wounds
Wounds and Injuries
Resuscitation
Survivors
Nervous System
Thorax
Costs and Cost Analysis
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Emergency department thoracotomy following injury : Critical determinants for patient salvage. / Timothy Baxter, B.; Moore, Ernest E.; Moore, John B.; Cleveland, Henry C.; McCroskey, Brian L.; Moore, Frederick A.

In: World Journal of Surgery, Vol. 12, No. 5, 01.10.1988, p. 671-674.

Research output: Contribution to journalArticle

Timothy Baxter, B. ; Moore, Ernest E. ; Moore, John B. ; Cleveland, Henry C. ; McCroskey, Brian L. ; Moore, Frederick A. / Emergency department thoracotomy following injury : Critical determinants for patient salvage. In: World Journal of Surgery. 1988 ; Vol. 12, No. 5. pp. 671-674.
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abstract = "The role of emergency department (ED) thoracotomy in resuscitation of the moribund trauma patient remains ill-defined. The purpose of this article is to analyze our experience during the past decade in order to elucidate prognostic features enabling a more cost-effective application of this heroic measure. Injury mechanism in the 632 ED thoracotomies performed in our trauma consortium consisted of blunt (BLT) in 50{\%}, gunshot wounds (GSW) in 35{\%}, and stab wounds (SW) in 15{\%}. Mean patient age was 31 years, and 76{\%} were men. Twenty-nine (5{\%}) of the patients were ultimately discharged alive from the hospital. Outcome was analyzed on the basis of physiologic status at presentation to the ED: group I, n=481 (76{\%}), presented without signs of life (SL); group II, n=38 (6{\%}), presented with SL (pupillary response), but without vital signs (VS); and group III, n=113 (18{\%}), presented with VS. Survival without SL was 10{\%} of SW, 1{\%} of GSW, and 1{\%} of BLT. When VS were present, patient salvage was 32{\%} following SW, 15{\%} following GSW, and 5{\%} after blunt trauma. Five of 15 survivors without SL had irreversible cerebral damage; whereas, 13 of the 14 survivors with VS had no permanent neurologic sequelae. This experience underscores the rationale for selective application of ED thoracotomy done for postinjury resuscitation; functional salvage of the blunt trauma victim arriving lifeless is nil while nearly one-third of patients in extremis from a thoracic SW can be returned to their preinjury state.",
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