Role of urgent thoracotomy in improving the survival of patients with severe chest trauma

ABSTRACT

To determine the frequency of survival in patients with thoracic trauma, undergoing Urgent Thoracotomy [UT]. Quasi-experimental study. The study was carried out in the Department of Thoracic Surgery, JPMC, Karachi, from January 2005 to June 2007 [30 months]. Fifty two patients, who presented with chest trauma and underwent UT within 48 hours of sustaining thoracic trauma, were included in the study. All patients were assessed by history, physical examination and relevant investigations. A total of 475 patients with acute thoracic trauma needing admission during the study period presented to the Accidents and Emergency Department. Fifty-two [52/475; 10.9%] patients were indicated for UT. The most common indication for UT was massive hemothorax [43/52; 82.6%]. The mean age of the patients was 34.36 +/- 11.02 years. There were 22 [42.2%] blunt injuries and 30 [57.8%] penetrating injuries. Road Traffic Accidents [RTA] were the most frequent cause of blunt chest injuries [15 patients; 75%], while firearm injury was the commonest [21 patients; 70%] cause of penetrating chest trauma. Post thoracotomy mortality was 13.3% [4 out of 30] in patients with penetrating injuries and 18.2% [4 out of 22] in patients with blunt injuries [p < 0.01]. Mortality of UT was 15.3% with survival of 84.7%. Overall survival in 475 patients was 95.58%. Early recognition of treatable injuries and an aggressive approach in management with Urgent Thoracotomy can increase chances of survival of patients suffering from severe chest trauma