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Data Clarify Diagnosis, Treatment of Thoracoabdominal Trauma

Major Finding: The majority of patients with isolated thoracoabdominal trauma arriving alive and without severe head trauma (72.3%) were managed conservatively, without thoracotomy or laparotomy. Only 0.8% of patients required a thoracotomy alone.

Data Source: The study was based on a trauma registry and medical record review of 1,661 thoracoabdominal trauma patients.

Disclosures: The authors reported having no relevant financial disclosures.


 

FROM ARCHIVES OF SURGERY

In cases of blunt thoracoabdominal trauma, the abdomen should be the initial cavity of exploration in patients requiring emergent surgery without direct radiologic data, based on the results of a trauma registry and medical record review of 1,661 patients.

Abdominal exploration first is justified because rarely are nonresuscitative thoracotomy or combined thoracoabdominal operations needed, researchers stated in the June issue of Archives of Surgery.

"To our knowledge, the current study is the most complete examination of injury patterns and outcomes in the largest series of blunt thoracoabdominal trauma patients to date," wrote study investigators Dr. Regan J. Berg and colleagues in the division of trauma surgery and surgical critical care, Los Angeles County + University of Southern California Medical Center in Los Angeles.

The researchers retrospectively studied all patients with blunt thoracoabdominal trauma (defined as an Abbreviated Injury Score of 2 or more in both the chest and abdomen) who were admitted to the LAC+USC Medical Center between January 1996 and December 2010. They examined a trauma registry and obtained additional data from the review of individual medical records.

A total of 1,667 patients fulfilled the inclusion criteria, but 6 were excluded for incomplete medical data. The most frequent causes of injury in the remaining 1,661 patients were motor vehicle collision (68.1%), falls (15.6%), and motorcycle collisions (10.4%), with assault accounting for only 1.8% of patients (Arch. Surg. 2012;147:498-504).

Most patients with isolated thoracoabdominal trauma arriving alive and without severe head trauma (821/1,135 patients, or 72.3%) were managed conservatively, without thoracotomy or laparotomy. Only 9/1,135 patients (0.8%) required a thoracotomy alone. Of those, three had the thoracotomy in the operating room, and six patients had resuscitative therapy (RT) performed outside the operating room for postadmission cardiac arrest or hemodynamic deterioration, according to the researchers.

Laparotomy alone was required in 281 (24.8%), while only 24 patients (2.1%) had both a laparotomy and a thoracotomy; 7 patients (0.6%) had a laparotomy following RT.

Independent risk factors of mortality included an Injury Severity Score of 25 or more, a Glasgow Coma Scale score of 8 or less, the need for massive transfusions, age of 55 years or older, and the need for dual-cavity intervention. Among injury patterns, liver, abdominal vascular, and cardiac injury were independently associated with mortality, they added.

"Most thoracic procedures were performed for resuscitative purposes with low survival rates, in keeping with previous literature. Furthermore, concomitant thoracic injury did not preclude nonoperative management of abdominal solid organ injury, with a degree of success comparable with previous reports," the researchers concluded.

The authors reported that they had no relevant financial disclosures.

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