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


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.


Trauma registry Emergency room thoracotomy Resuscitative thoracotomy Chest trauma Polytrauma 



American College of Surgeons


Abbreviated Injury Scale


Cardiopulmonary resuscitation


Computed tomography


Chest X-ray


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


Quality Management


Regional Trauma Center (Level II)


Revised Injury Severity Classification


Signs of life


Supraregional Trauma Center (Level I)


TraumaRegister DGU®


United States of America


Whole body computed tomography


Western Trauma Association


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.


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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