OUTCOME OF A STRICT POLICY ON EMERGENCY DEPARTMENT THORACOTOMIES

Objective: To audit emergency department thoracotomies from January 19 81 to May 1993. Design: Retrospective analysis of case records. Settin g: 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 d uring the above period. Intervention: An emergency department thoracot omy was performed on trauma patients with recordable vital signs and r apid deterioration and on patients with uncontrollable bleeding or pro found hypotension not responsive to resuscitation. The procedure was p erformed either on the resuscitation trolley in the emergency departme nt 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 wit h 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 manage ment of trauma patients. The best results are obtained in patients wit h penetrating chest injuries.