Emergency department thoracotomy of severely injured patients: an analysis of the TraumaRegister DGU®
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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.
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.
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.
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.
KeywordsTrauma registry Emergency room thoracotomy Resuscitative thoracotomy Chest trauma Polytrauma
American College of Surgeons
Abbreviated Injury Scale
German Trauma Society
Emergency Department Thoracotomy
Focused Abdomen Sonography in Trauma
Glasgow Coma Scale
Local Trauma Center (Level III)
Injury Severity Score
Millimeter of Mercury
Regional Trauma Center (Level II)
Revised Injury Severity Classification
Signs of life
Supraregional Trauma Center (Level I)
United States of America
Whole body computed tomography
Western Trauma Association
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.
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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