title: The double jeopardy of blunt thoracoabdominal trauma.
abstract: OBJECTIVE
  To examine the specific injuries, need for operative intervention, and clinical outcomes of patients with blunt thoracoabdominal trauma.
  
  
  METHODS
  Trauma registry and medical record review.
  
  
  METHODS
  Level I trauma center in Los Angeles, California.
  
  
  METHODS
  All patients with thoracoabdominal injuries from January 1996 to December 2010.
  
  
  METHODS
  Injuries, incidence and type of operative intervention, clinical outcomes, and risk factors for mortality.
  
  
  RESULTS
  Blunt thoracoabdominal injury occurred in 1661 patients. Overall, 474 (28.5%) required laparotomy, 31 (1.9%) required thoracotomy (excluding resuscitative thoracotomy), and 1146 (69.0%) required no thoracic or abdominal operation. Overall incidence of intraabdominal solid organ injury was 59.7% and hollow viscus injury, 6.0%. Blunt cardiac trauma occurred in 6.3%; major thoracic vessel injury, in 4.6%; and diaphragmatic trauma, in 6.0%. The majority of solid organ injuries were managed nonoperatively (liver, 83.9%; spleen, 68.3%; and kidney, 91.2%). Excluding patients with severe head trauma, mortality ranged from 4.5% with nonoperative management to 18.1% and 66.7% in those requiring laparotomy and dual cavitary exploration, respectively. Age 55 years or older, Injury Severity Score of 25 or more, Glasgow Coma Scale score of 8 or less, initial hypotension, massive transfusion, and liver, cardiac, or abdominal vascular trauma were all independent risk factors for mortality.
  
  
  CONCLUSIONS
  Most patients with blunt thoracoabdominal trauma are managed nonoperatively. The need for non-resuscitative thoracotomy or combined thoracoabdominal operation is rare. The abdomen contains the overwhelming majority of injuries requiring operative intervention and should be the initial cavity of exploration in the patient requiring emergent surgery without directive radiologic data.
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA 90033, USA.
authors.forename: Regan J
authors.initials: RJ
authors.lastname: Berg
authors.forename: Obi
authors.initials: O
authors.lastname: Okoye
authors.forename: Pedro G
authors.initials: PG
authors.lastname: Teixeira
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007668:Kidney / Q000293:injuries; D007813:Laparotomy; D007902:Length of Stay; D008099:Liver / Q000293:injuries; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013154:Spleen / Q000293:injuries; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D013908:Thoracotomy; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D055815:Young Adult