SURGICAL-MANAGEMENT OF MAJOR THORACIC INJURIES

Major thoracic injuries are uncommon in the United Kingdom and wide ex perience of their management by centres in this country has not been r eported. Between 1985 and 1990, 23 patients have undergone urgent thor acotomy at Birmingham Accident Hospital for suspected intrathoracic in jury, The majority of these injuries were caused by penetrating trauma (13 patients). The commonest indications for thoracotomy were suspect ed intrathoracic haemorrhage in 13 patients and suspected cardiac tamp onade in four patients. In three of the four patients with suspected c ardiac tamponade, the diagnosis was cowed, the tamponade successfully relieved together with repair of the lesion, and all three patients su rvived. Of the 13 patients with intrathoracic haemorrhage, 10 survived after control of haemorrhage and repair of the lesion but three died: one from uncontrollable haemorrhage from a right middle lobe vessel l aceration, one from associated multiple injuries and one from post-ope rative complications. The TRISS methodology was applied to audit our r esults. Two patients who died after a penetrating injury had a greater than 50 per cent probability of death by the TRISS method. Two patien ts who died after a blunt injury had a less than 50 per cent probabili ty of death by the TRISS method although one of these patients died fr om postoperative complications. This series illustrates the point that prompt recognition of a suspected intrathoracic injury and appropriat e urgent surgical intervention to relieve cardiac tamponade and contro l intrathoracic haemorrhage in these patients can produce a successful outcome. In addition it it is essential that all units audit their ow n results in order to highlight areas where improvements in trauma car e can be made.