title: Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands.
abstract: BACKGROUND
  Most patients with penetrating chest injuries benefit from early treatment with chest tube drainage or surgery. Although penetrating chest injury is not uncommon, few descriptive studies are published, especially in Europe. The aim of this study was to review our experience and further improve our management of penetrating chest injuries in a level I trauma center in the Netherlands.
  
  
  METHODS
  All patients with penetrating chest injury between August 2004 and December 2012 were included. Demographics, mechanism of injury, physiological parameters, Injury Severity Scores (ISS), surgical and non-surgical treatment, length of intensive care unit (ICU) stay, length of hospital stay (LOS), complications and rate of mortality were collected.
  
  
  RESULTS
  A total of 159 patients were analyzed. Patients included 116 (73 %) stab wounds and 34 (21 %) gunshot wounds. In 27 patients (17 %), cardiac injury was seen. The mean ISS was 12. Almost half of all patients (49 %) were treated with only chest tube drainage. Alternatively, surgical treatment was performed in 24 % of all cases. Anterolateral incision was most frequently used to gain access to the thoracic cavity. The mean LOS was 9 days. Among all patients, 17 % were admitted to the ICU with a mean stay of 3 days. In 18 (11 %) patients, one or more complications occurred. The 30-day mortality was 7.5 %.
  
  
  CONCLUSIONS
  Patients presenting with penetrating chest injury are not uncommon in the Netherlands and can mostly be treated conservatively. In one-fourth of the patients, surgical treatment is performed. A structural and vigorous approach is needed for good clinical outcome.
authors.affiliation: Department of Trauma Surgery, VU University Medical Center, 7F029, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Heus
authors.affiliation: Department of Trauma Surgery, VU University Medical Center, 7F029, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Mellema
authors.affiliation: Department of Trauma Surgery, VU University Medical Center, 7F029, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: G F
authors.initials: GF
authors.lastname: Giannakopoulos
authors.affiliation: Department of Trauma Surgery, VU University Medical Center, 7F029, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. w.zuidema@vumc.nl.
authors.forename: W P
authors.initials: WP
authors.lastname: Zuidema
mesh_terms: D000328:Adult; D015505:Chest Tubes; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D000069258:Thoracentesis; D013898:Thoracic Injuries / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D013908:Thoracotomy; D014193:Trauma Centers; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D014951:Wounds, Stab / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D055815:Young Adult
keywords: Chest injuries; Outcome; Penetrating; Trauma