| Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center. | |
| | |
MedLine Citation:
|
PMID: 9680018 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Despite numerous studies, no clear consensus exists for the optimal use of emergency department thoracotomy (EDT). As such, we have continued to critically review our experience with EDT during the last 23 years to clarify indications for EDT and evaluate its cost-effectiveness. METHODS: This was a retrospective review of 950 EDTs performed at our regional Level I trauma center during the last 23 years. Cost-benefit ratios were calculated using standardized models. RESULTS: In 23 years, 950 patients underwent postinjury thoracotomy. We were able to obtain the complete medical records for 868 patients (91%). Overall survival was 4.4%, with 3.9% surviving functionally intact. All survivors of blunt trauma had either palpable pulse or recorded blood pressure in the field. Blunt trauma functional survival when field vital signs were present was 2.5%. Of note, 26.5% of our functional survivors sustained penetrating injuries and had no pulse or blood pressure in the field. Stab wounds to the chest and gunshot wounds to the abdomen were the two mechanisms of injury most likely to be survived. The benefit-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 neurologically injured survivors throughout their lifetime. CONCLUSION: EDT is efficacious 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 neurologically intact survivors. |
| | |
Authors:
|
S W Branney; E E Moore; K M Feldhaus; R E Wolfe |
Related Documents
:
|
6826598 - Doppler-determined segmental pressures and wound-healing in amputations for vascular di... 8697128 - High-compression bandages. 488148 - Healing of enterotomies with preexisting peritonitis. an experimental study in guinea p... 16649178 - Pathophysiological advantages of rinsing-suction-reaming (rsr) in a pig model for intra... 1876248 - Prevention of an air embolism by moderate hypoventilation during surgery in the sitting... 236908 - The calcium paradox: a reaffirmation. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The Journal of trauma Volume: 45 ISSN: 0022-5282 ISO Abbreviation: J Trauma Publication Date: 1998 Jul |
Date Detail:
|
Created Date: 1998-08-12 Completed Date: 1998-08-12 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 0376373 Medline TA: J Trauma Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 87-94; discussion 94-5 Citation Subset: AIM; IM |
Affiliation:
|
Denver Health Medical Center, Colorado 80204, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Colorado Cost-Benefit Analysis Emergency Treatment / economics*, methods Female Humans Male Middle Aged Multiple Trauma / economics*, surgery* Retrospective Studies Thoracotomy / economics*, methods Trauma Centers / economics*, standards Utilization Review |
| Comments/Corrections | |
Comment In:
|
J Trauma. 1999 May;46(5):983
[PMID:
10338432
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Trauma in pregnancy: maternal and fetal outcomes.
Next Document: Prehospital pulseless, unconscious penetrating trauma victims: field assessments associated with sur...