Outcome of a strict policy on emergency department thoracotomies.

OBJECTIVE: To audit emergency department thoracotomies from January 1981 to May 1993.

DESIGN: Retrospective analysis of case records.

SETTING: A large (3000-bed) tertiary care academic hospital; the department of general surgery (including trauma) consists of 360 beds.

PATIENTS: All patients who underwent a thoracotomy in the emergency department during the above period.

INTERVENTION: An emergency department thoracotomy was performed on trauma patients with recordable vital signs and rapid deterioration and on patients with uncontrollable bleeding or profound hypotension not responsive to resuscitation. The procedure was performed either on the resuscitation trolley in the emergency department or in the adjacent operating room.

MAIN OUTCOME MEASURES: Survival and subsequent neurological function after thoracotomy.

RESULTS: There were 312 stab injuries, 358 gunshot injuries, and 176 blunt injuries. Survival occurred in 26 stab-wound cases (8.3%), in 16 gunshot cases (4.4%), and in one blunt injury case (0.6%). There was one patient with neurological impairment in each of the three injury groups. Those with penetrating chest injuries had the best survival rate (20%), and the survival rate for penetrating abdominal trauma was 6.8%.

CONCLUSIONS: Emergency department thoracotomies have a definite role in the management of trauma patients. The best results are obtained in patients with penetrating chest injuries.