Comparison of penetrating thoracic traumas in patients with gunshot and stab wounds in an emergency department

Abstract

Objectives: Thoracic trauma is among the most important causes of mortality in emergency departments. In this study of penetrating stab wounds (PSWs) and gunshot wounds (GSWs) admitted to the emergency department with penetrating thoracic trauma cases clinical findings, emergency treatment approaches and survivals were compared with literature information.

Methods: One hundred fifty-two patients who applied to Bakırköy Dr. Sadi Konuk Training and Research Hospital Emergency Department with penetrating thoracic trauma on 1 January 2014 and 31 December 2014 were evaluated retrospectively the patients. SPSS 22.0, NY, USA program was used in the analyzes.

Results: Patients administered with PSW were 79.6%, with GSW were 20.4%. Patients in the group GSW were admitted to the emergency department with more serious symptoms than patients in the group PSW (Triage level 2, GSW: 87.1%, PSW: 62.8% and Triage level 3, GSW: 12.9% vs. PSW: 37.2%), (p = 0.010). Hemothorax (25.8%) in PSW patients and pneumothorax (40.5%) in GSW patients was detected more frequently. Surgical treatment was performed in 14.9% of patients with PSW, tube thoracostomy was performed in 24%, and 62.82% were treated with conservative treatment. Surgical treatment was performed in 35.5% of GSW patients and tube thoracostomy was performed in 29%, and 48.4% were treated with conservative treatment (p > 0.05).

Conclusion: Despite the lower incidence of GSW than PSW in emergency departments, GSW require more surgical intervention and have a higher mortality rate. 

Keywords

• thoracic trauma,emergency,triage,mortality,penetrating

References

1. 1. Battistella FD, Benfield JR. Blunt and penetrating injuries of the chest wall, pleura, and lungs. In: Shields TW. General Thoracic Surgery. 5th ed. Philadelphia: Williams and Wilkins; 2000:pp. 815-63.
2. 2. Durso AM, Caban K, Munera F. Penetrating thoracic injury. Radiol Clin North Am 2015;53:675-93.
3. 3. Kayıhan A, Yavuz Ş, Ünal M, Sanisoğlu İ, Canik S, Eren E. [Traumatic laseration of left anterior descending artery and revascularization]. Turk Gogus Kalp Dama 1992;1:127-30. [Article in Turkish]
4. 4. Ata Y, Türk T, Yalçın M, Selimoğlu Ö, Özyazıcıoğlu A, Yavuz Ş. [Heart Injury]. İ Ü Kardiyol Enst Derg 2009;8:16-9. [Article in Turkish]
5. 5. Burack JH, Kandil E, Sawas A, O'Neill PA, Sclafani SJ, Lowery RC, et al. Triage and outcome of patients with mediastinal penetrating trauma. Ann Thorac Surg 2007;83:377-82; discussion 382.
6. 6. ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg 2013;74:1363-6.
7. 7. Madiba TE, Thomson SR, Mdlalose N. Penetrating chest injuries in the firearm era. Injury 2001;32:13-6.
8. 8. Ludwig C, Koryllos A. Management of chest trauma. J Thorac Dis 2017;9(Suppl 3):S172-S177.

9. 9. Liman ST. Thoracic traumas. [Specialized thesis] Ankara: Ankara Chest Diseases and Thoracic Surgery Center; 1997.
10. 10. Kong VY, Sartorius B, Clarke DL. The selective conservative management of penetrating thoracic trauma is still appropriate in the current era. Injury 2015;46:49-53.
11. 11. Yücel O, Sapmaz E, Çaylak H, Gözübüyük A, Gürkök S, Dakak M, et al. Analysis of 748 patients with thoracic trauma requiring hospitalization. Gulhane Med J 2009;51:86-90.
12. 12. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med 2000;7:236-42.
13. 13. Travers DA, Waller AE, Bowling JM, Flowers D, Tintinalli J. Five-level triage system more effective than three-level in tertiary emergency department. J Emerg Nurs 2002;28:395-400.
14. 14. Cakan A, Yuncu G, Olgaç G, Alar T, Sevinç S, Ors Kaya S, et al. [Thoracic trauma: analysis of 987 cases]. Ulus Travma Derg 2001;7:236-41. [Article in Turkish]
15. 15. Hasbahçeci M, Ozpek A, Başak M, Calışkan M, Ener BK, Alimoğlu O. [Factors affecting mortality in blunt thoracic trauma]. Ulus Travma Acil Cerrahi Derg 2013;19:127-32.
16. 16. Emircan S, Ozgüç H, Akköse Aydın SA, Ozdemir F, Köksal O, Bulut M. Factors affecting mortality in patients with thorax trauma. Ulus Travma Acil Cerrahi Derg 2011;17:329-33.
17. 17. Costa G, Tomassini F, Tierno SM, Venturini L, Frezza B, Cancrini G, et al. The prognostic significance of thoracic and abdominal trauma in severe trauma patients (Injury severity score > 15). Ann Ital Chir 2010;81:171-6.
18. 18. Eftekhar B, Zarei MR, Ghodsi M, Moezardalan K, Zargar M, Ketabchi E. Comparing logistic models based on modified GCS motor component with other prognostic tools in prediction of mortality: results of study in 7226 trauma patients. Injury 2005;36:900-4.
19. 19. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma 1989;29:623-9.
20. 20. Lema MK, Chalya PL, Mabula JB, Mahalu W. Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania. J Cardiothorac Surg. 2011;6:7.
21. 21. Thomas MO, Ogunleye EO. Etiopathology and management challenges of blunt chest trauma in Nigeria. Asian Cardiovasc Thorac Ann 2009;17:608-11.
22. 22. Şentürk E, Doğan Y, Yoldaş E. [Chest trauma; analysis of 1142 cases]. Turk Thorac J 2010;11:47-54. [Article in Turkish]
23. 23. Washington B, Wilson RF, Steiger Z, Bassett JS. Emergency thoracotomy: a four-year review. Ann Thorac Surg 1985;40:188-91.
24. 24. Gopinath N. Thoracic trauma. Indian J Thorac Cardiovasc Surg 2004;20:144-8.
25. 25. Çağırıcı U, Uç H, Çalkavur T, Gürcün U, Badak İ, Bilkay Ö, et al. [Thoracic trauma: the 6-year experience]. Ulus Travma Derg 1998;4:248-52. [Article in Turkish
26. 26. Clarke DL, Quazi MA, Reddy K, Thomson SR. Emergency operation for penetrating thoracic trauma in a metropolitan surgical service in South Africa. J Thorac Cardiovasc Surg 2011;142:563-8.