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Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries.
Eur J Trauma Emerg Surg 2018; 44(1):55-61EJ

Abstract

BACKGROUND

Operative interventions are uncommonly required for penetrating pulmonary injuries. Similarly, because their incidence is low, few series appear sporadically in the literature. Objectives of this study are to identify predictors of outcome for patients requiring emergent thoracotomy for penetrating pulmonary injuries and evaluate the use of tissue sparing versus resective techniques for their management.

STUDY DESIGN

This is a retrospective 169-month study of all patients with penetrating pulmonary injuries requiring thoracotomy. The main outcome measures are: physiologic parameters, AAST-OIS injury grade, surgical procedures and mortality. Statistical analysis includes univariate and stepwise logistic regression.

RESULTS

101 patients required thoracotomy for penetrating pulmonary injuries. Mechanism of injury includes: gunshot wounds (GSW)-73 (72%), stab wounds (SW)-28 (33%). Mean systolic BP 97 ± 47, mean HR 92 ± 47, and mean admission pH 7.22 ± 0.17. Mean RTS 6.25 ± 2.7, mean ISS 36 ± 22. The mean estimated blood loss (EBL) was 5277 ± 4955 mls. Predictors of outcome are: admission pH (p = 0.0014), admission base deficit (p < 0.0001), packed red blood cells (PRBCs) transfused (p = 0.023), whole blood transfused (p < 0.01). A total of 143 procedures were required in 101 patients: tissue sparing 114 (80%) versus resective procedures 29 (20%). Only pneumonectomy (p = 0.024) predicted outcome. Overall survival 64/101-64%. American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) injury grades I-III versus IV-VI predicts survival (p < 0.001). Stepwise logistic regression identified AAST-OIS injury grades IV-VI (p = 0.007; OR 6.38 [95% CI 1.64-24.78]), intraoperative dysrhythmias (p = 0.003; OR 17.38 [95% CI 2.59-116.49]) and associated cardiac injuries (p = 0.02; OR 8.74 [95% CI 1.37-55.79]) as independent predictors of outcome.

CONCLUSIONS

Predictors of outcome for penetrating pulmonary injuries requiring thoracotomy are identified and must be taken into account in their operative management. Tissue sparing techniques-stapled pulmonary tractotomy is once again validated, and it remains effective as the mainstay for their management; however, only pneumonectomy predicts outcome. AAST-OIS injury grades IV-VI predict outcome with higher injury grades requiring resective procedures.

Authors+Show Affiliations

Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA. juanasensio@creighton.edu.Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA.Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA.Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA.Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA.Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28573429

Citation

Asensio, J A., et al. "Predictors of Outcome in 101 Patients Requiring Emergent Thoracotomy for Penetrating Pulmonary Injuries." European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society, vol. 44, no. 1, 2018, pp. 55-61.
Asensio JA, Ogun OA, Mazzini FN, et al. Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries. Eur J Trauma Emerg Surg. 2018;44(1):55-61.
Asensio, J. A., Ogun, O. A., Mazzini, F. N., Perez-Alonso, A. J., Garcia-Núñez, L. M., & Petrone, P. (2018). Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries. European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society, 44(1), pp. 55-61. doi:10.1007/s00068-017-0802-x.
Asensio JA, et al. Predictors of Outcome in 101 Patients Requiring Emergent Thoracotomy for Penetrating Pulmonary Injuries. Eur J Trauma Emerg Surg. 2018;44(1):55-61. PubMed PMID: 28573429.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries. AU - Asensio,J A, AU - Ogun,O A, AU - Mazzini,F N, AU - Perez-Alonso,A J, AU - Garcia-Núñez,L M, AU - Petrone,P, Y1 - 2017/06/01/ PY - 2017/01/13/received PY - 2017/05/29/accepted PY - 2017/6/3/pubmed PY - 2018/10/3/medline PY - 2017/6/3/entrez KW - Cardiac KW - Injuries KW - Penetrating KW - Shock SP - 55 EP - 61 JF - European journal of trauma and emergency surgery : official publication of the European Trauma Society JO - Eur J Trauma Emerg Surg VL - 44 IS - 1 N2 - BACKGROUND: Operative interventions are uncommonly required for penetrating pulmonary injuries. Similarly, because their incidence is low, few series appear sporadically in the literature. Objectives of this study are to identify predictors of outcome for patients requiring emergent thoracotomy for penetrating pulmonary injuries and evaluate the use of tissue sparing versus resective techniques for their management. STUDY DESIGN: This is a retrospective 169-month study of all patients with penetrating pulmonary injuries requiring thoracotomy. The main outcome measures are: physiologic parameters, AAST-OIS injury grade, surgical procedures and mortality. Statistical analysis includes univariate and stepwise logistic regression. RESULTS: 101 patients required thoracotomy for penetrating pulmonary injuries. Mechanism of injury includes: gunshot wounds (GSW)-73 (72%), stab wounds (SW)-28 (33%). Mean systolic BP 97 ± 47, mean HR 92 ± 47, and mean admission pH 7.22 ± 0.17. Mean RTS 6.25 ± 2.7, mean ISS 36 ± 22. The mean estimated blood loss (EBL) was 5277 ± 4955 mls. Predictors of outcome are: admission pH (p = 0.0014), admission base deficit (p < 0.0001), packed red blood cells (PRBCs) transfused (p = 0.023), whole blood transfused (p < 0.01). A total of 143 procedures were required in 101 patients: tissue sparing 114 (80%) versus resective procedures 29 (20%). Only pneumonectomy (p = 0.024) predicted outcome. Overall survival 64/101-64%. American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) injury grades I-III versus IV-VI predicts survival (p < 0.001). Stepwise logistic regression identified AAST-OIS injury grades IV-VI (p = 0.007; OR 6.38 [95% CI 1.64-24.78]), intraoperative dysrhythmias (p = 0.003; OR 17.38 [95% CI 2.59-116.49]) and associated cardiac injuries (p = 0.02; OR 8.74 [95% CI 1.37-55.79]) as independent predictors of outcome. CONCLUSIONS: Predictors of outcome for penetrating pulmonary injuries requiring thoracotomy are identified and must be taken into account in their operative management. Tissue sparing techniques-stapled pulmonary tractotomy is once again validated, and it remains effective as the mainstay for their management; however, only pneumonectomy predicts outcome. AAST-OIS injury grades IV-VI predict outcome with higher injury grades requiring resective procedures. SN - 1863-9941 UR - https://www.unboundmedicine.com/medline/citation/28573429/Predictors_of_outcome_in_101_patients_requiring_emergent_thoracotomy_for_penetrating_pulmonary_injuries L2 - https://dx.doi.org/10.1007/s00068-017-0802-x DB - PRIME DP - Unbound Medicine ER -