Acute injuries of the trachea and major bronchi: importance of early diagnosis.
BACKGROUND
Tracheobronchial injuries are encountered with increasing frequency because of improvements in prehospital care and early initiation of the Advanced Trauma Life Support protocol. We review our experience with these injuries with the hypothesis that the leading determinant of patient outcome is the time interval to diagnosis.


METHODS
Patients with tracheobronchial injury were identified from the registry of our level 1 trauma center during a 10-year period ending December 1997. Clinical presentation, diagnostic evaluation, surgical management, and outcome were reviewed.


RESULTS
Twenty patients with ten cervical tracheal injuries and ten intrathoracic tracheobronchial injuries were treated. The mechanism of injury involved blunt trauma in 11 and penetrating trauma in 9. All patients underwent surgical debridement and primary repair. Patients with isolated airway injuries were discharged home after a mean hospital stay of 6 days and had no early complications. Three patients had delayed diagnosis (> 24 hours), and all sustained complications including death (1 patient) and multiorgan system failure (2 patients). The overall mortality rate was 15%.


CONCLUSIONS
Operative management of tracheobronchial injuries can be achieved with acceptable mortality. Independent of mechanism or anatomic location of injury, delay in diagnosis is the single most important factor influencing outcome. Early recognition of tracheobronchial injury and expedient institution of appropriate surgical intervention are essential in these potentially lethal injuries.
Cassada
D C
DC
Department of Surgery, The University of Tennessee Medical Center at Knoxville, 37920, USA.
Munyikwa
M P
MP
Moniz
M P
MP
Dieter
R A
RA
Schuchmann
G F
GF
Enderson
B L
BL
D000293:Adolescent; D000328:Adult; D001980:Bronchi / Q000293:injuries* / Q000601:surgery; D002648:Child; D003646:Debridement; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D014132:Trachea / Q000293:injuries* / Q000601:surgery; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery