| Transmediastinal gunshot wounds in a mature trauma centre: Changing perspectives. | |
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MedLine Citation:
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PMID: 23298755 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Transmediastinal gunshot wounds are associated with a high mortality and frequently require operative intervention. The purpose of this study was to identify the diagnostic and therapeutic challenges of these injuries in a mature trauma system with decreasing prehospital time intervals. METHODS: Patients admitted to a large urban Level 1 trauma centre between 1/2006 and 12/2010 sustaining a firearm injury to the torso were identified. Transmediastinal gunshot wounds were defined as missile tracts traversing the mediastinum identified on CT images, operative notes or autopsy reports. RESULTS: Overall, 133 patients met study criteria. A total of 116 patients (87.2%) were haemodynamically unstable or had no vital signs on arrival to the Emergency Department. Ninety-seven (83.6%) of these patients required a resuscitative thoracotomy resulting in 8 survivors (6.0%). There were 17 haemodynamically stable patients (12.8%) identified, 14 of whom underwent CT scan evaluation. Six patients subsequently required operative intervention. Only 11 patients (8.3%) in the study population were successfully managed nonoperatively. The overall mortality was 78.9%, and for those who reached the hospital with vital signs, the mortality was 24.3%. CONCLUSIONS: Transmediastinal gunshot wounds encountered in a mature trauma centre are highly lethal injuries requiring resuscitative thoracotomy in most instances. Changing perspectives in these injuries may reflect the effects of an evolving prehospital care. |
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Authors:
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Obi T Okoye; Peep Talving; Pedro G Teixeira; Michael Chervonski; Jennifer A Smith; Kenji Inaba; Thomas T Noguchi; Demetrios Demetriades |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2013-1-5 |
Journal Detail:
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Title: Injury Volume: - ISSN: 1879-0267 ISO Abbreviation: Injury Publication Date: 2013 Jan |
Date Detail:
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Created Date: 2013-1-9 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0226040 Medline TA: Injury Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 Elsevier Ltd. All rights reserved. |
Affiliation:
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Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA, United States. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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