Selective nonoperative management of penetrating thoracic injury

Oscar J. F. van Waes, Jens A. Halm, Diederik I. van Imhoff, Pradeep H. Navsaria, Andrew J. Nicol, Michael H. J. Verhofstad, Jefrey Vermeulen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Thoracic penetrating injury is a cause for up to one-fifth of all non-natural deaths. The aim of this study was to determine the success of selective nonoperative management (SNOM) of patients presenting with a penetrating thoracic injury (PTI). Methods: This was a prospective study of patients with PTI who presented to a level 1 Trauma Center between April 2012 and August 2012. Results: A total of 248 patients were included in the study, with 5.7% (n=14) requiring immediate emergency surgery. Overall, five of these 248 patients died, resulting in a mortality rate of 2.0%. Primarily 221 patients (89.1%) were managed with SNOM, of whom 15 (6.8%) failed conservative management. Failure of SNOM was primarily caused by complications of chest tube drainage (n=12) (e.g. retained clot, empyema) and delayed development of cardiac tamponade (n=3). The survival rate in the SNOM group was 100%. Conclusion: PTI has a low in-hospital mortality rate. Only 16.5% (41/248) of the patients presenting with PTI will need surgical treatment. The other patients are safe to be treated conservatively according to a protocolized SNOM approach for PTI without any additional mortality. Conservative treatment of patients who were selected for this nonoperative treatment strategy with repeated clinical reassessment was successful in 93.2%.
Original languageEnglish
Pages (from-to)32-38
JournalEuropean Journal of Emergency Medicine
Volume25
Issue number1
DOIs
Publication statusPublished - 2018
Externally publishedYes

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