Selective nonoperative management of penetrating thoracic injury.
BACKGROUND
Thoracic penetrating injury is a cause for up to one-fifth of all non-natural deaths. The aim of this study was to determine the success of selective nonoperative management (SNOM) of patients presenting with a penetrating thoracic injury (PTI).


METHODS
This was a prospective study of patients with PTI who presented to a level 1 Trauma Center between April 2012 and August 2012.


RESULTS
A total of 248 patients were included in the study, with 5.7% (n=14) requiring immediate emergency surgery. Overall, five of these 248 patients died, resulting in a mortality rate of 2.0%. Primarily 221 patients (89.1%) were managed with SNOM, of whom 15 (6.8%) failed conservative management. Failure of SNOM was primarily caused by complications of chest tube drainage (n=12) (e.g. retained clot, empyema) and delayed development of cardiac tamponade (n=3). The survival rate in the SNOM group was 100%.


CONCLUSIONS
PTI has a low in-hospital mortality rate. Only 16.5% (41/248) of the patients presenting with PTI will need surgical treatment. The other patients are safe to be treated conservatively according to a protocolized SNOM approach for PTI without any additional mortality. Conservative treatment of patients who were selected for this nonoperative treatment strategy with repeated clinical reassessment was successful in 93.2%.
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam.
Oscar J F
OJF
Van Waes
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam.
Jens A
JA
Halm
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam.
Diederik I
DI
Van Imhoff
Trauma Center, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Pradeep H
PH
Navsaria
Trauma Center, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Andrew J
AJ
Nicol
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam.
Michael H J
MHJ
Verhofstad
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam.|Department of Surgery-Traumatology, Spaarne Gasthuis, Haarlem, The Netherlands.
Jefrey
J
Vermeulen
D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010614:Pharynx / Q000293:injuries*; D011446:Prospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*