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Blunt Chest Trauma in Polytraumatized Patients: Predictive Factors for Urgent Thoracotomy
Josef Stolberg-Stolberg1, Jan Christoph Katthagen1, Thomas Hillemeyer2
1Department of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, Germany.
Insights
Chest-tube output is the key predictor for urgent thoracotomy in blunt chest trauma. Over 1300 mL of chest-tube output in 24 hours indicates a need for transfer to a trauma center with thoracic surgery capabilities.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Emergency Medicine
Background:
- Current urgent thoracotomy guidelines are based on penetrating chest injuries.
- Blunt chest trauma requires distinct predictive factors for urgent surgical intervention.
Purpose of the Study:
- To identify predictive factors for urgent thoracotomy in polytraumatized patients with blunt chest trauma.
- To refine clinical decision-making for thoracic surgical intervention after chest-tube placement.
Main Methods:
- Retrospective analysis of 235 polytraumatized patients with blunt chest trauma treated over 12 years.
- Inclusion criteria: Injury Severity Score ≥16 and at least one chest tube.
- Analysis of trauma mechanism, chest-tube output, hemoglobin, blood products, coagulopathy, rib fractures, thoracotomy, and mortality.
Main Results:
- Urgent thoracotomy (UT) patients (n=10) had significantly higher 24-hour chest-tube output (median 3865 mL) compared to non-UT patients (NT, n=225, median 185 mL; p<0.001).
- A 24-hour chest-tube output cutoff of 1270 mL predicted the need for thoracotomy.
- No significant differences in initial hemoglobin or INR values between UT and NT groups.
Conclusions:
- Chest-tube output is the most critical predictor for urgent thoracotomy in blunt chest trauma.
- Patients with >1300 mL chest-tube output within 24 hours should be considered for transfer to a Level I trauma center with thoracic surgery standby.
Purpose:
Current guidelines on urgent thoracotomy of polytraumatized patients are based on data from perforating chest injuries. We aimed to identify predictive factors for urgent thoracotomy after chest-tube placement for blunt chest trauma in a civilian setting.
Methods:
Polytraumatized patients (Injury Severity Score ≥16) with blunt chest trauma, submitted to a level I trauma centre during a period of 12 years that received at least one chest tube were included. Trauma mechanism, chest-tube output, haemoglobin values, need for cellular blood products, coagulopathies, rib fracture pattern, thoracotomy, and mortality were retrospectively analysed.
Results:
235 polytraumatized patients were included. Patients that received urgent thoracotomy (UT, n = 10) showed a higher mean chest-tube output within 24 h with a median (Mdn) of 3865 (IQR 2423-5156) mL compared to the group with no additional thoracic surgery (NT, n = 225) with Mdn 185 (IQR 50-463) mL (p < 0.001). The cut-off 24-h chest-tube output value for recommended thoracotomy was 1270 mL (ROC-Curve). UT showed an initial haemoglobin of Mdn 11.7 (IQR 9.2-14.3) g/dL and an INR value of Mdn 1.27 (IQR 1.11-1.69) as opposed to Mdn 12.3 (IQR 10-13.9) g/dL and Mdn 1.13 (IQR 1.05-1.34) in NT (haemoglobin: p = 0.786; INR: p = 0.215). There was an average number of 7.1(±3.4) rib fractures in UT and 6.7(±4.8) in NT (p = 0.649).
Conclusions:
Chest-tube output remains the single most important predictive factor for urgent thoracotomy also after blunt chest trauma. Patients with a chest-tube output of more than 1300 mL within 24 h after trauma should be considered for transfer to a level I trauma centre with standby thoracic surgery.
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