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The role of emergency department thoracotomy in patients with cranial gunshot wounds.
- Source :
-
The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2024 Aug 01; Vol. 97 (2), pp. 220-224. Date of Electronic Publication: 2024 Feb 20. - Publication Year :
- 2024
-
Abstract
- Background: Although several society guidelines exist regarding emergency department thoracotomy (EDT), there is a lack of data upon which to base guidance for multiple gunshot wound (GSW) patients whose injuries include a cranial GSW. We hypothesized that survival in these patients would be exceedingly low.<br />Methods: We used Pennsylvania Trauma Outcomes Study data, 2002 to 2021, and included EDTs for GSWs. We defined EDT by International Classification of Diseases codes for thoracotomy or procedures requiring one, with a location flagged as emergency department. We defined head injuries as any head Abbreviated Injury Scale (AIS) score of ≥1 and severe head injuries as head AIS score of ≥4. Head injuries were "isolated" if all other body regions have an AIS score of <2. Descriptive statistics were performed. Discharge functional status was measured in five domains.<br />Results: Over 20 years in Pennsylvania, 3,546 EDTs were performed; 2,771 (78.1%) were for penetrating injuries. Most penetrating EDTs (2,003 [72.3%]) had suffered GSWs. Survival among patients with isolated head wounds (n = 25) was 0%. Survival was 5.3% for the non-head injured (n = 94 of 1,787). In patients with combined head and other injuries, survival was driven by the severity of the head wound-0% (0 of 81) with a severe head injury ( p = 0.035 vs. no severe head injury) and 4.5% (5 of 110) with a nonsevere head injury. Of the five head-injured survivors, two were fully dependent for transfer mobility, and three were partially or fully dependent for locomotion. Of 211 patients with a cranial injury who expired, 2 (0.9%) went on to organ donation.<br />Conclusion: Although there is clearly no role for EDT in patients with isolated head GSWs, EDT may be considered in patients with combined injuries, as most of these patients have minor head injuries and survival is not different from the non-head injured. However, if a severe head injury is clinically apparent, even in the presence of other body cavity injuries, EDT should not be pursued.<br />Level of Evidence: Therapeutic/Care Management; Level IV.<br /> (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Adult
Pennsylvania epidemiology
Abbreviated Injury Scale
Middle Aged
Head Injuries, Penetrating surgery
Head Injuries, Penetrating mortality
Retrospective Studies
Young Adult
Injury Severity Score
Craniocerebral Trauma surgery
Craniocerebral Trauma mortality
Adolescent
Wounds, Gunshot surgery
Wounds, Gunshot mortality
Thoracotomy statistics & numerical data
Thoracotomy methods
Emergency Service, Hospital statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 2163-0763
- Volume :
- 97
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The journal of trauma and acute care surgery
- Publication Type :
- Academic Journal
- Accession number :
- 38374530
- Full Text :
- https://doi.org/10.1097/TA.0000000000004282