Outcome of a strict policy on emergency department thoracotomies
G. C. Velmahos, E. Degiannis, I. Souter, A. C. Allwood and R. Saadia
Department of Surgery, Baragwanath Hospital, Johannesburg, South Africa.
OBJECTIVE: To audit emergency department thoracotomies from January 1981 to
May 1993. DESIGN: Retrospective analysis of case records. SETTING: A large
(3000-bed) tertiary care academic hospital; the department of general
surgery (including trauma) consists of 360 beds. PATIENTS: All patients who
underwent a thoracotomy in the emergency department during the above
period. INTERVENTION: An emergency department thoracotomy was performed on
trauma patients with recordable vital signs and rapid deterioration and on
patients with uncontrollable bleeding or profound hypotension not
responsive to resuscitation. The procedure was performed either on the
resuscitation trolley in the emergency department or in the adjacent
operating room. MAIN OUTCOME MEASURES: Survival and subsequent neurological
function after thoracotomy. RESULTS: There were 312 stab injuries, 358
gunshot injuries, and 176 blunt injuries. Survival occurred in 26
stab-wound cases (8.3%), in 16 gunshot cases (4.4%), and in one blunt
injury case (0.6%). There was one patient with neurological impairment in
each of the three injury groups. Those with penetrating chest injuries had
the best survival rate (20%), and the survival rate for penetrating
abdominal trauma was 6.8%. CONCLUSIONS: Emergency department thoracotomies
have a definite role in the management of trauma patients. The best results
are obtained in patients with penetrating chest injuries.
