CRITICAL ANALYSIS OF 2 DECADES OF EXPERIENCE WITH POSTINJURY EMERGENCY DEPARTMENT THORACOTOMY IN A REGIONAL TRAUMA CENTER

Background: Despite numerous studies, no clear consensus exists for th e optimal use of emergency department thoracotomy (EDT), As such, we h ave continued to critically review our experience with EDT during the last 23 years to clarify indications for EDT and evaluate its cost-eff ectiveness. Methods: This was a retrospective review of 950 EDTs perfo rmed at our regional Level I trauma center during the last 23 years. C ost-benefit ratios were calculated using standardized models. Results: In 23 years, 950 patients underwent postinjury thoracotomy, We were a ble to obtain the complete medical records for 868 patients (91%), Ove rall survival was 4.4%, with 3.9% surviving functionally intact. All s urvivors of blunt trauma had either palpable pulse or recorded blood p ressure in the field. Blunt trauma functional survival when field vita l signs were present was 2.5%, Of note, 26.5% of our functional surviv ors sustained penetrating injuries and had no pulse or blood pressure in the field. Stab wounds to the chest and gunshot wounds to the abdom en were the two mechanisms of injury most likely to be survived, The b enefit-charge ratio was strongly in favor of performing EDT at 5.6:1; it was 1.8:1 if adjusted for the cost of maintaining all neurologicall y injured survivors throughout their lifetime. Conclusion: EDT is effi cacious and cost-effective for select patient populations, We suggest a key clinical pathway for the use of EDT that would reduce the number of procedures by at least 32% without changing the number of neurolog ically intact survivors.