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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 3/2020

01-06-2020 | Thoracic Trauma | Original Article

Emergency department thoracotomy of severely injured patients: an analysis of the TraumaRegister DGU®

Authors: Stefan Schulz-Drost, David Merschin, Denis Gümbel, Gerrit Matthes, Friedrich Frank Hennig, Axel Ekkernkamp, Rolf Lefering, Sebastian Krinner, the TraumaRegister DGU

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2020

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Abstract

Aim of the study

Emergency department thoracotomy (EDT) may be the last chance for survival in some severe thoracic trauma. This study investigates a representative collective with the aim to compare the findings in Europe to the international experience. Moreover, the influence of different levels of trauma care is investigated.

Methods

All emergency thoracotomies in patients with an ISS ≥ 9 from TR-DGU (2009–2014) within the first 60 min after arrival were identified. EDTs were identified separately, and mini thoracotomies and drainage systems were excluded.

Results

99,013 patients with sufficient data were observed. 1736 (1.8%) received thoracotomy during their hospital stay. 887 patients had a thoracotomy within the first hour in the emergency department (ED). 52.5% were treated in supraregional trauma centers (STC), 36.4% in regional (RTC) and 11.0% in local trauma centers (LTC). The mortality rates were 39.4% (STC), 20.9% (RTC) and 20.8% (LTC). The overall mortality rate showed no significant differences for blunt (28.2%) and penetrating trauma (31.3%). In case of cardiac arrest in the ED, a survival rate of 4.8% for blunt trauma and 20.7% for penetrating trauma was determined if EDT was carried out. Those patients showed a higher rate in severe thoracic organ injuries due to penetrating trauma but less extrathoracic injuries.

Conclusion

Just over half of EDTs were performed in STC. Emergency room resuscitation followed by EDT had survival rates of 4.8% and 20.7% for blunt and penetrating trauma patients, respectively.
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Metadata
Title
Emergency department thoracotomy of severely injured patients: an analysis of the TraumaRegister DGU®
Authors
Stefan Schulz-Drost
David Merschin
Denis Gümbel
Gerrit Matthes
Friedrich Frank Hennig
Axel Ekkernkamp
Rolf Lefering
Sebastian Krinner
the TraumaRegister DGU
Publication date
01-06-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01212-3

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