TY - JOUR
T1 - Selective nonoperative management of penetrating thoracic injury
AU - van Waes, Oscar J. F.
AU - Halm, Jens A.
AU - van Imhoff, Diederik I.
AU - Navsaria, Pradeep H.
AU - Nicol, Andrew J.
AU - Verhofstad, Michael H. J.
AU - Vermeulen, Jefrey
PY - 2018
Y1 - 2018
N2 - 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%.
AB - 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%.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84963979911&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/27092768
U2 - https://doi.org/10.1097/MEJ.0000000000000401
DO - https://doi.org/10.1097/MEJ.0000000000000401
M3 - Article
C2 - 27092768
SN - 0969-9546
VL - 25
SP - 32
EP - 38
JO - European Journal of Emergency Medicine
JF - European Journal of Emergency Medicine
IS - 1
ER -