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Penetrating thoracic injuries: what we have learnt
U O von Oppell1, P Bautz, M De Groot
1Department of Cardiothoracic Surgery, University of Cape Town, South Africa. uvonopp@thoracic.cts.uct.ac.za
The Thoracic and Cardiovascular Surgeon
|April 11, 2000
Summary
Penetrating chest trauma, particularly cardiac and vascular injuries, has high mortality. Prompt transport, triage, and surgical intervention are crucial for improving survival rates in these critical cases.
Area of Science:
- Trauma Surgery
- Cardiothoracic Surgery
- Emergency Medicine
Background:
- Penetrating thoracic injuries, including cardiac, vascular, and transmediastinal, represent a significant cause of mortality.
- High pre-hospital mortality rates are associated with penetrating cardiac (86%) and extrapericardial vascular (92%) injuries.
Purpose of the Study:
- To review the experience at Groote Schuur Hospital with penetrating chest wounds.
- To analyze mortality and treatment outcomes for various types of penetrating thoracic trauma.
Main Methods:
- Retrospective review of approximately 1,000 annual admissions for penetrating chest wounds between 1982 and 1997.
- Analysis of mortality based on injury type, clinical presentation, and anatomical involvement.
Main Results:
- Pulmonary injuries had a lower mortality (11%) compared to cardiac and vascular injuries.
- Less than 10% of hemothorax cases required surgery, with thoracoscopic clot evacuation being largely successful.
- Mortality for penetrating cardiac injuries varied significantly by presentation (moribund 52%, hypovolemia 20%, tamponade 2-5%) and chamber injured, with atrial injuries having higher mortality.
Conclusions:
- Intercostal drains and therapeutic thoracoscopy are key for non-cardiac penetrating thoracic trauma.
- Rapid transport, immediate triage, emergency room thoracotomy, and aggressive surgical management, including pericardial windows, improve survival for penetrating cardiac trauma.