title: Emergency room thoracotomy for penetrating chest injury: effect of an institutional protocol.
abstract: BACKGROUND
  Emergency room thoracotomy (ERT) can be life saving in patients with penetrating chest injury. A protocol was established at our institution stating that ERT be performed for cases of cardiac tamponade secondary to penetrating chest trauma on patients with vital signs/mentation in the field or on arrival to the emergency room. To validate our protocol, we reevaluated patients undergoing ERT at our institution.
  
  
  METHODS
  In our retrospective review, there were 49 patients undergoing ERT over a 6-year period.
  
  
  RESULTS
  Survival in patients with vital signs was approximately 50%. Survival in those without was 0%. Compared with the preprotocol data, the number of ERTs declined from 32.2 cases per year to 8.1 cases per year. Overall survival increased from 4% to 20%. Neurologic outcome remained unchanged.
  
  
  CONCLUSIONS
  We believe that the data validate our protocol, and the establishment of a guideline has enabled us to maximize patient survival and minimize exposure risks to our staff.
authors: Department of Surgery, Section on Trauma, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA. rie.aihara@bmc.org
authors: R
authors: R
authors: Aihara
authors: F H
authors: FH
authors: Millham
authors: J
authors: J
authors: Blansfield
authors: E F
authors: EF
authors: Hirsch
mesh_terms: D001900:Boston / Q000453:epidemiology; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000401:mortality / Q000601:surgery*; D013908:Thoracotomy / Q000592:standards / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*