CHAPTER 95 ED THORACOTOMIES

Critical Analysis of Two Decades of Experience with Postinjury Emergency Department Thoracotomy in a Regional Trauma Center

Branney SW, Moore EE, Feldhaus KM, Wolfe RE. J Trauma. 1998;45(1):87–94

BACKGROUND

Emergency department thoracotomy (EDT) is a life-saving procedure when performed for the appropriate indications. Despite this, indiscriminate use results in increased cost and exposes health care providers to significant occupational risk. Prior to this study, there was no clear pathway to guide the use of EDT and many patients in extremis were treated with futile thoracotomy.

OBJECTIVES

Evaluate outcomes in patients receiving EDT based on the presence or absence of vital signs (VSs) and the mechanism of injury.

METHODS

Retrospective chart review in a US regional Level 1 trauma center between 1974 and 1997.

Patients

868 patients who underwent EDT and had complete medical records in a 23-year period. Blunt trauma accounted for 45%, Gun shot wound (GSW) 38%, and stab wounds stab wound (SWs) for 17%. Prehospital information was available for all patients after 1980 (n = 590).

Intervention Evaluated

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