Selective nonoperative management of penetrating thoracic injury
Background: Thoracic penetrating injury is a cause for up to one-fifth of all non-natural deaths. The aim of this study was to determine the success of selective nonoperative management (SNOM) of patients presenting with a penetrating thoracic injury (PTI). Methods: This was a prospective study of patients with PTI who presented to a level 1 Trauma Center between April 2012 and August 2012. Results: A total of 248 patients were included in the study, with 5.7% (n=14) requiring immediate emergency surgery. Overall, five of these 248 patients died, resulting in a mortality rate of 2.0%. Primarily 221 patients (89.1%) were managed with SNOM, of whom 15 (6.8%) failed conservative management. Failure of SNOM was primarily caused by complications of chest tube drainage (n=12) (e.g. retained clot, empyema) and delayed development of cardiac tamponade (n=3). The survival rate in the SNOM group was 100%. Conclusion: PTI has a low in-hospital mortality rate. Only 16.5% (41/248) of the patients presenting with PTI will need surgical treatment. The other patients are safe to be treated conservatively according to a protocolized SNOM approach for PTI without any additional mortality. Conservative treatment of patients who were selected for this nonoperative treatment strategy with repeated clinical reassessment was successful in 93.2%.
|Keywords||nonoperative, outcome, penetrating, thoracic, trauma|
|Persistent URL||dx.doi.org/10.1097/MEJ.0000000000000401, hdl.handle.net/1765/111115|
|Series||Surgery and Traumatology|
|Journal||European journal of emergency medicine : official journal of the European Society for Emergency Medicine|
van Waes, O.J.F, Halm, J.A, Van Imhoff, D.I. (Diederik I.), Navsaria, P.H, Nicol, A.J, Verhofstad, M.H.J, & Vermeulen, J. (2018). Selective nonoperative management of penetrating thoracic injury. European journal of emergency medicine : official journal of the European Society for Emergency Medicine, 25(1), 32–38. doi:10.1097/MEJ.0000000000000401