title: Outcome of a strict policy on emergency department thoracotomies.
abstract: OBJECTIVE
  To audit emergency department thoracotomies from January 1981 to May 1993.
  
  
  METHODS
  Retrospective analysis of case records.
  
  
  METHODS
  A large (3000-bed) tertiary care academic hospital; the department of general surgery (including trauma) consists of 360 beds.
  
  
  METHODS
  All patients who underwent a thoracotomy in the emergency department during the above period.
  
  
  METHODS
  An emergency department thoracotomy was performed on trauma patients with recordable vital signs and rapid deterioration and on patients with uncontrollable bleeding or profound hypotension not responsive to resuscitation. The procedure was performed either on the resuscitation trolley in the emergency department or in the adjacent operating room.
  
  
  METHODS
  Survival and subsequent neurological function after thoracotomy.
  
  
  RESULTS
  There were 312 stab injuries, 358 gunshot injuries, and 176 blunt injuries. Survival occurred in 26 stab-wound cases (8.3%), in 16 gunshot cases (4.4%), and in one blunt injury case (0.6%). There was one patient with neurological impairment in each of the three injury groups. Those with penetrating chest injuries had the best survival rate (20%), and the survival rate for penetrating abdominal trauma was 6.8%.
  
  
  CONCLUSIONS
  Emergency department thoracotomies have a definite role in the management of trauma patients. The best results are obtained in patients with penetrating chest injuries.
authors.affiliation: Department of Surgery, Baragwanath Hospital, Johannesburg, South Africa.
authors.forename: G C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: E
authors.initials: E
authors.lastname: Degiannis
authors.forename: I
authors.initials: I
authors.lastname: Souter
authors.forename: A C
authors.initials: AC
authors.lastname: Allwood
authors.forename: R
authors.initials: R
authors.lastname: Saadia
mesh_terms: D000328:Adult; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D013898:Thoracic Injuries / Q000401:mortality / Q000601:surgery*; D013908:Thoracotomy / Q000706:statistics & numerical data*; D016896:Treatment Outcome