AN EFFECTIVE METHOD FOR EVALUATING AND MANAGING THORACIC TRAUMA PATIENTS

Background: The objective of this study was to assess the diagnostic a nd therapeutic effectiveness of videothoracoscopy in thoracic trauma p atients. Methods: The design was a retrospective review. The setting w as a major trauma center at an urban county hospital. Forty-one hemody namically stable patients sustaining thoracic trauma were reviewed (34 penetrating and 7 blunt injuries). In the acute setting (<24 h), vide othoracoscopy was used for continued bleeding (6) and suspected diaphr agmatic injury (17). Thoracoscopy was used in delayed settings (>24 h) for treatment of thoracic trauma complications (18) including clotted hemothorax (14), persistent air leak (1), widened mediastinum (I), an d suspected diaphragmatic injury (2). Results: The average Injury Seve rity Score (ISS) of these patients was 18.9 +/- 10.0. Three of 6 patie nts (50%) with continued bleeding were successfully treated thoracosco pically. Nine of 10 (90%) diaphragmatic injuries were confirmed by tho racoscopy, and 7 of these 9 patients (77%) were repaired thoracoscopic ally. Thirteen of 14 patients (93%) with clotted hemothoraces and one with a persistent air leak were treated successfully using thoracoscop y. An aortic injury was ruled out in one patient. Conclusions: Videoth oracoscopy is a safe, accurate, minimally invasive, and potentially co st-effective method for the diagnosis and therapeutic management of th oracic trauma patients.