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Emergency department thoracotomy of severely injured patients: an analysis of the TraumaRegister DGU®

  • Stefan Schulz-DrostEmail author
  • David Merschin
  • Denis Gümbel
  • Gerrit Matthes
  • Friedrich Frank Hennig
  • Axel Ekkernkamp
  • Rolf Lefering
  • Sebastian Krinner
  • the TraumaRegister DGU
Original Article
  • 32 Downloads

Abstract

Aim of the study

Emergency department thoracotomy (EDT) may be the last chance for survival in some severe thoracic trauma. This study investigates a representative collective with the aim to compare the findings in Europe to the international experience. Moreover, the influence of different levels of trauma care is investigated.

Methods

All emergency thoracotomies in patients with an ISS ≥ 9 from TR-DGU (2009–2014) within the first 60 min after arrival were identified. EDTs were identified separately, and mini thoracotomies and drainage systems were excluded.

Results

99,013 patients with sufficient data were observed. 1736 (1.8%) received thoracotomy during their hospital stay. 887 patients had a thoracotomy within the first hour in the emergency department (ED). 52.5% were treated in supraregional trauma centers (STC), 36.4% in regional (RTC) and 11.0% in local trauma centers (LTC). The mortality rates were 39.4% (STC), 20.9% (RTC) and 20.8% (LTC). The overall mortality rate showed no significant differences for blunt (28.2%) and penetrating trauma (31.3%). In case of cardiac arrest in the ED, a survival rate of 4.8% for blunt trauma and 20.7% for penetrating trauma was determined if EDT was carried out. Those patients showed a higher rate in severe thoracic organ injuries due to penetrating trauma but less extrathoracic injuries.

Conclusion

Just over half of EDTs were performed in STC. Emergency room resuscitation followed by EDT had survival rates of 4.8% and 20.7% for blunt and penetrating trauma patients, respectively.

Keywords

Trauma registry Emergency room thoracotomy Resuscitative thoracotomy Chest trauma Polytrauma 

Abbreviations

ACS

American College of Surgeons

AIS

Abbreviated Injury Scale

CPR

Cardiopulmonary resuscitation

CT

Computed tomography

CXR

Chest X-ray

DGU

German Trauma Society

EDT

Emergency Department Thoracotomy

FAST

Focused Abdomen Sonography in Trauma

GCS

Glasgow Coma Scale

LTC

Local Trauma Center (Level III)

ISS

Injury Severity Score

mmHg

Millimeter of Mercury

QM

Quality Management

RTC

Regional Trauma Center (Level II)

RISC

Revised Injury Severity Classification

SOL

Signs of life

STC

Supraregional Trauma Center (Level I)

TR-DGU

TraumaRegister DGU®

USA

United States of America

WBCT

Whole body computed tomography

WTA

Western Trauma Association

Notes

Author contributions

SSD, SK and RL had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, especially any adverse effects. DM, DG, GM, AE, FFH and RL contributed substantially to the study design, data analysis and interpretation as well as the writing of the manuscript.

Funding

No funding has been received in connection to this study.

Compliance with ethical standards

Conflict of interest

The first author S. Schulz-Drost is a member of the AO TK Thoracic Surgery Expert Group (THEG). He also has a consultant agreement with DePuySynthes and works for the national DSTC™ program. S. Schulz-Drost, D. Merschin, D. Gümbel and G. Matthes work for the national ATLS® program. The other authors state that they are not involved in any conflicts of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Stefan Schulz-Drost
    • 1
    • 2
    Email author
  • David Merschin
    • 1
  • Denis Gümbel
    • 1
    • 3
  • Gerrit Matthes
    • 1
    • 3
  • Friedrich Frank Hennig
    • 2
  • Axel Ekkernkamp
    • 1
    • 3
  • Rolf Lefering
    • 4
  • Sebastian Krinner
    • 2
  • the TraumaRegister DGU
  1. 1.Department for Trauma Surgery and OrthopaedicsBG Klinikum Unfallkrankenhaus Berlin gGmbHBerlinGermany
  2. 2.Department of Orthopaedic and Trauma SurgeryUniversitätsklinikum ErlangenErlangenGermany
  3. 3.Centre of Orthopaedics, Trauma Surgery and Rehabilitative Medicine, Ferdinand-Sauerbruch-StraßeUniversitätsmedizin GreifswaldGreifswaldGermany
  4. 4.Faculty of Health, Department of Medicine, Institute for Research in Operative Medicine (IFOM)University Witten-HerdeckeCologneGermany

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