Document Detail

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    
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.
S W Branney; E E Moore; K M Feldhaus; R E Wolfe
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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    
Denver Health Medical Center, Colorado 80204, USA.
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MeSH Terms
Cost-Benefit Analysis
Emergency Treatment / economics*,  methods
Middle Aged
Multiple Trauma / economics*,  surgery*
Retrospective Studies
Thoracotomy / economics*,  methods
Trauma Centers / economics*,  standards
Utilization Review
Comment In:
J Trauma. 1999 May;46(5):983   [PMID:  10338432 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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