title: Timing of urgent thoracotomy for hemorrhage after trauma: a multicenter study.
abstract: OBJECTIVE
  It is possible to quantify an amount of thoracic hemorrhage, after blunt and penetrating injury, at which delay of thoracotomy is associated with increased mortality.
  
  
  METHODS
  A retrospective case series.
  
  
  METHODS
  Five urban trauma centers.
  
  
  METHODS
  Patients undergoing urgent thoracotomy (within 48 hours of injury) for hemorrhage (excluding emergency department thoracotomy).
  
  
  METHODS
  Respective registries identified patients who underwent urgent thoracotomy. Injury characteristics, initial and subsequent chest tube outputs, time before thoracotomy, and outcomes were evaluated.
  
  
  METHODS
  Death.
  
  
  RESULTS
  One hundred fifty-seven patients (36 with blunt and 121 with penetrating injuries) underwent urgent thoracotomy for hemorrhage between January 1, 1995, and December 31, 1998. Mortality correlated with mean (+/- SD) Injury Severity Score (38 +/- 19 vs 22 +/- 12.6 for survivors; P<.01) and mechanism (24 [67%] for blunt vs 21 [17%] for penetrating injuries; P<.01). Mortality increased as total chest blood loss increased, with the risk for death at blood loss of 1500 mL being 3 times greater than at 500 mL. Blunt-injured patients waited a significantly longer time to thoracotomy than penetrating-injured patients (4.4 +/- 9.0 h vs 1.6 +/- 3.0 h; P =.02) and also had a greater total chest tube output before thoracotomy (2220 +/- 1235 mL vs 1438 +/- 747 mL; P =.001).
  
  
  CONCLUSIONS
  The risk for death increases linearly with total chest hemorrhage after thoracic injury. Thoracotomy is indicated when total chest tube output exceeds 1500 mL within 24 hours, regardless of injury mechanism.
authors.affiliation: Department of Surgery, Campus Box 359796, 325 Ninth Ave, Harborview Medical Center, Seattle, WA 98104, USA. karmy@u.washington.edu
authors.forename: R
authors.initials: R
authors.lastname: Karmy-Jones
authors.forename: G J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: A B
authors.initials: AB
authors.lastname: Nathens
authors.forename: D V
authors.initials: DV
authors.lastname: Shatz
authors.forename: S
authors.initials: S
authors.lastname: Brundage
authors.forename: M J
authors.initials: MJ
authors.lastname: Wall
authors.forename: S
authors.initials: S
authors.lastname: Engelhardt
authors.forename: D B
authors.initials: DB
authors.lastname: Hoyt
authors.forename: J
authors.initials: J
authors.lastname: Holcroft
authors.forename: M M
authors.initials: MM
authors.lastname: Knudson
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D006470:Hemorrhage / Q000601:surgery*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000601:surgery*; D013908:Thoracotomy; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery