This paper is only available as a PDF. To read, Please Download here.
Abstract
Major thoracic injuries are uncommon in the United Kingdom and wide experience of
their management by centres in this country has not been reported. Between 1985 and
1990, 23 patients have undergone urgent thoracotomy at Birmingham Accident Hospital
for suspected intrathoracic injury. The majority of these injuries were caused by
penetrating trauma (13 patients). The commonest indications for thoracotomy were suspected
intrathoracic haemorrhage in 13 patients and suspected cardiac tamponade in four patients.
In three of the four patients with suspected cardiac tamponade, the diagnosis was
correct, the tamponade successfully relieved together with repair of the lesion, and
all three patients survived. Of the 13 patients with intrathoracic haemorrhage, 10
survived after control of haemorrhage and repair of the lesion but three died: one
from uncontrollable haemorrhage from a right middle lobe vessel laceration, one from
associated multiple injuries and one from post-operative complications.
The TRISS methodology was applied to audit our results. Two patients who died after
a penetrating injury had a greater than 50 per cent probability of death by the TRISS
method. Two patients who died after a blunt injury had a less than 50 per cent probability
of death by the TRISS method although one of these patients died from postoperative
complications.
This series illustrates the point that prompt recognition of a suspected intrathoracic
injury and appropriate urgent surgical intervention to relieve cardiac tamponade and
control intrathoracic haemorrhage in these patients can produce a successful outcome.
In addition it it is essential that all units audit their own results in order to
highlight areas where improvements in trauma care can be made.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Advanced Trauma Life Support Course Handbook. American College of Surgeons, 1988
- Retrospective study of 1000 deaths from injury in England and Wales.Br. Med. J. 1988; 296: 1305
- The role of emergency room thoracotomy in trauma.J. Trauma. 1980; 20: 848
- The injury severity score; a method for describing patients with multiple injuries and evaluating emergency care.J. Trauma. 1974; 14: 187
- Evaluating trauma care: the TRISS method.J. Trauma. 1987; 27: 370
- Injury scoring by TRISS and ISS/age.Injury. 1991; 21: 127
- Trauma severity scales.in: Advances in Trauma. vol. 1. Year Book Medical Publishers, Chicago1986: 1
- Trauma score.Crit. Care Med. 1991; 9: 672
- Confidential Enquiry into Perioperative Deaths (CEPOD).1987
- Penetrating injuries of the heart: experience over two years in South Africa.J. Trauma. 1983; 23: 1034
- Cardiac penetrating injuries: personal experience of 45 cases.Br. J. Surg. 1984; 71: 95
- Indications for thoracotomy in stab injuries of the chest: a prospective study of 543 patients.Br. J. Surg. 1986; 73: 888
- Commission on the Provision of Surgical Services.in: A report by the Working Party on the Management of Patients with Multiple Injuries. Royal College of Surgeons of England, 1988
- Penetrating cardiac injuries: twenty years experience.Am. Surg. 1987; 53: 10
- Sharp thoracic injury.Injury. 1989; 20: 22
- Should emergency room thoracotomy be reserved for cases of cardiac tamponade?.Injury. 1991; 22: 5
- Thoracic injury requiring surgery.World J. Surg. 1983; 7: 49
- Surgical management of stab wounds of the chest.J. R. Coll. Surg. Edinb. 1988; 33: 78
- Indications for thoracotomy following penetrating thoracic injury.J. Trauma. 1977; 17: 493
- Penetrating cardiac injuries.Br. Med. J. 1987; 294: 1630
- Management of penetrating cardiac injuries. The role of emergency room thoracotomy.Ann. Thorac. Surg. 1984; 38: 183
Article info
Publication history
Accepted:
September 14,
1993
Identification
Copyright
© 1994 Published by Elsevier Inc.
