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The Limited Role of Emergency Department Thoracotomy in Penetrating Neck Trauma
Justin S Hatchimonji1, Diane N Haddad1, Phillip Kemp Bohan2
1Section of Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, Illinois.
Introduction:
Current emergency department thoracotomy (EDT) guidelines do not distinguish between extrathoracic injuries. We hypothesized EDT is not associated with lower odds of mortality in pulseless penetrating neck trauma patients.
Materials And Methods:
We used Trauma Quality Improvement Project data, 2017-2021, including pulseless adults (≥16 y) with isolated penetrating neck trauma, proceeding to operating room (OR) or dying in the emergency department. The primary outcome was mortality; secondary outcomes were survival to OR and transfusion requirement.
Results:
There were 262 patients. Of these, 110 (42.0%) injuries were gunshot wounds. A total of 30/262 patients (11.5%) underwent EDT. All 30 (100%) died in the hospital, while 9/232 (3.9%) non-EDT patients survived (P = 0.27). All 9 survivors had suffered stab wounds. Of the EDT patients, 7/30 (23.3%) survived to OR, whereas 24/232 (10.3%) survived to OR without EDT (P = 0.04).
Conclusions:
EDT may facilitate survival to operation in penetrating neck trauma, but is not associated with improved mortality. This may be due to the unique positioning of injuries proximal to aortic cross-clamp.
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