Klinik Araştırma
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Emergency major surgery in thoracic trauma: Timing and decision process

Yıl 2021, Cilt 2, Sayı 3, 204 - 211, 22.09.2021

Öz

Background: Surgery is required in 10-15% of patients with thoracic injuries. Surgery performed within the first few hours of the injury is considered as an emergency surgery. The aim of study is to share our experiences with emergency surgical approaches in thoracic trauma. Methods: Our study was carried out between June 2012-June 2020, by retrospective analysis of cases who were evaluated for thoracic trauma in the emergency department and who underwent emergency surgery. Results: There were 5784 patients who requested for thoracic surgery consultation due to thoracic trauma. Of these cases, 1317 (22.8%) were patients who were evaluated in the emergency service due to isolated thoracic trauma. There were 18 patients (1.3%) who underwent emergency surgery for isolated thoracic trauma. Glasgow score was higher in the group that was discharged after recovery among all groups; and this was statistically significant (p= 0.045). It was statistically significant that intubation and low modified trauma scores were a poor prognostic factor (respectively p= 0.035, p=0,025). Conclusions: Tube thoracostomy is sufficient for most of the thoracic traumas. After emergency evaluation, fast and correct decision in the appropriate surgical indication significantly reduces mortality.

Kaynakça

  • 1.Eray O. Approach to Multiple Trauma Patient (Golden Hour). Dogan R, Tastepe I, Liman ST (editors). Trauma. 1th, Ankara: MN Medikal & Nobel; 2006: pp.93-103.
  • 2. Çakan A,Yuncu G, Olgaç G, Alar T, Sevinc S, et al. Thoracic trauma: analysis of 987 cases. Ulus Travma Derg. 2001; 7(4): 236-241.
  • 3. Kahraman C, Akçal Y, Emirogulları N et al. Künt toraks travması. Erciyes Tıp Dergisi. 1995; 17: 318-324.
  • 4. Kish G, Kozloff L, Joseph WL, Adkins PC. Indications for early thoracotomy in the management of chest trauma. Ann Thorac Surg 1976;22(1):23-8.
  • 5. Hines MH, Meredith JW. Special problems of thoracic trauma. In: Ritchie WP, Steele Jr G, Dean RH (editors). General surgery. Philadelphia: JB Lippincott; 1995. pp. 859–72
  • 6. Onat S, Ulku R, Avci A, Ates G, Ozcelik C. Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center. Injury 2011;42(9):900-4.
  • 7.Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma 1989; 29(5): 623-9.
  • 8.Adebonojo SA. Management of chest trauma: a review. West Afr J Med 1993;12(2):122-32.
  • 9.Wall Jr MJ, Storey JH, Mattox KL. Indications for thoracotomy. In: Mattox KL, Feliciano DV, Moore EE (editors). Trauma. 4th ed. New York: McGraw-Hill; 2000. pp. 473
  • 10.Ali N, Gali BM. Pattern and management of chest injuries in Maiduguri, Nigeria. Ann Afr Med 2004;3(4):181-4.
  • 11.Siemens R, Polk HC, Gray LA, Fulton RL. Indications for thoracotomy following penetrating thoracic injury. J Trauma 1977(7);17: 493-500.
  • 12.Oparah S, Mandal A. Operative management of penetrating wounds of the chest in civilian practice. J Thorac Cardiouasc Surg 1979;77(2):162-8. 13.Hines MH, Meredith JW. Special problems of thoracic trauma. In: Ritchie WP,Steele Jr G, Dean RH (editors). General surgery. Philadelphia: JB Lippincott; 1995.pp. 859–72.
  • 14.Thompson DA, Rowlands BJ, Walker WE, Kuykendall RC, Miller PW, et al. Urgent thoracotomy for pulmonary or tracheobronchial injury. J Trauma 1988;28(3):276–80.
  • 15.Karmy-Jones R, Nathens A, Jurkovich GJ, Shatz DV, Brundage S, Wall MJ Jr, et al. Urgent and emergent thoracotomy for penetrating chest trauma. J Trauma 2004;56(3):664–668.
  • 16.Zakharia AT. Cardiovascular and thoracic battle in the Lebanon war: Analysis of 3,000 personal cases. J Thorac Cardiovasc Surg 1985;89(5):723-733.
  • 17.Degiannis E, Loogna P, Doll D, Bonanno F, Bowley DM, Smith MD. Penetrating cardiac injuries: recent experience in south africa. World J Surg 2006;30:1258–64.
  • 18.Karmy-Jones R, Jurkovich GJ, Nathens AB, Shatz DV, Brundage S, Wall MJ Jr, et al. Timing of urgent thoracotomy for hemorrhage after trauma: a multicenter study. Arch Surg 2001;136(5):513–8.
  • 19.Asensio JA, Arroyo Jr H, Veloz W, Forno W, Gambaro E, Roldan GA, et al. Penetrating thoracoabdominal injuries:ongoing dilemma—which cavity and when? World J Surg 2002;26(5):539–43.
  • 20.Hirshberg A, Wall Jr MJ, Allen MK, Mattox K. Double jeopardy: thoracoabdominal injuries requiring surgical intervention in both chest and abdomen. J Trauma 1995;39(2):225-231

Yıl 2021, Cilt 2, Sayı 3, 204 - 211, 22.09.2021

Öz

Kaynakça

  • 1.Eray O. Approach to Multiple Trauma Patient (Golden Hour). Dogan R, Tastepe I, Liman ST (editors). Trauma. 1th, Ankara: MN Medikal & Nobel; 2006: pp.93-103.
  • 2. Çakan A,Yuncu G, Olgaç G, Alar T, Sevinc S, et al. Thoracic trauma: analysis of 987 cases. Ulus Travma Derg. 2001; 7(4): 236-241.
  • 3. Kahraman C, Akçal Y, Emirogulları N et al. Künt toraks travması. Erciyes Tıp Dergisi. 1995; 17: 318-324.
  • 4. Kish G, Kozloff L, Joseph WL, Adkins PC. Indications for early thoracotomy in the management of chest trauma. Ann Thorac Surg 1976;22(1):23-8.
  • 5. Hines MH, Meredith JW. Special problems of thoracic trauma. In: Ritchie WP, Steele Jr G, Dean RH (editors). General surgery. Philadelphia: JB Lippincott; 1995. pp. 859–72
  • 6. Onat S, Ulku R, Avci A, Ates G, Ozcelik C. Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center. Injury 2011;42(9):900-4.
  • 7.Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma 1989; 29(5): 623-9.
  • 8.Adebonojo SA. Management of chest trauma: a review. West Afr J Med 1993;12(2):122-32.
  • 9.Wall Jr MJ, Storey JH, Mattox KL. Indications for thoracotomy. In: Mattox KL, Feliciano DV, Moore EE (editors). Trauma. 4th ed. New York: McGraw-Hill; 2000. pp. 473
  • 10.Ali N, Gali BM. Pattern and management of chest injuries in Maiduguri, Nigeria. Ann Afr Med 2004;3(4):181-4.
  • 11.Siemens R, Polk HC, Gray LA, Fulton RL. Indications for thoracotomy following penetrating thoracic injury. J Trauma 1977(7);17: 493-500.
  • 12.Oparah S, Mandal A. Operative management of penetrating wounds of the chest in civilian practice. J Thorac Cardiouasc Surg 1979;77(2):162-8. 13.Hines MH, Meredith JW. Special problems of thoracic trauma. In: Ritchie WP,Steele Jr G, Dean RH (editors). General surgery. Philadelphia: JB Lippincott; 1995.pp. 859–72.
  • 14.Thompson DA, Rowlands BJ, Walker WE, Kuykendall RC, Miller PW, et al. Urgent thoracotomy for pulmonary or tracheobronchial injury. J Trauma 1988;28(3):276–80.
  • 15.Karmy-Jones R, Nathens A, Jurkovich GJ, Shatz DV, Brundage S, Wall MJ Jr, et al. Urgent and emergent thoracotomy for penetrating chest trauma. J Trauma 2004;56(3):664–668.
  • 16.Zakharia AT. Cardiovascular and thoracic battle in the Lebanon war: Analysis of 3,000 personal cases. J Thorac Cardiovasc Surg 1985;89(5):723-733.
  • 17.Degiannis E, Loogna P, Doll D, Bonanno F, Bowley DM, Smith MD. Penetrating cardiac injuries: recent experience in south africa. World J Surg 2006;30:1258–64.
  • 18.Karmy-Jones R, Jurkovich GJ, Nathens AB, Shatz DV, Brundage S, Wall MJ Jr, et al. Timing of urgent thoracotomy for hemorrhage after trauma: a multicenter study. Arch Surg 2001;136(5):513–8.
  • 19.Asensio JA, Arroyo Jr H, Veloz W, Forno W, Gambaro E, Roldan GA, et al. Penetrating thoracoabdominal injuries:ongoing dilemma—which cavity and when? World J Surg 2002;26(5):539–43.
  • 20.Hirshberg A, Wall Jr MJ, Allen MK, Mattox K. Double jeopardy: thoracoabdominal injuries requiring surgical intervention in both chest and abdomen. J Trauma 1995;39(2):225-231

Ayrıntılar

Birincil Dil İngilizce
Konular Tıp
Bölüm ORIGINAL ARTICLE
Yazarlar

Eray ÇINAR
Turkish Ministry of Health, General Directorate of Emergency Medical Services
0000-0002-4564-6097
Türkiye


Kubilay İNAN
Ankara City Hospital, Department of Thoracic Surgery
0000-0002-1409-4760
Türkiye


Ozgur Omer YİLDİZ (Sorumlu Yazar)
Ankara Yıldırım Beyazıt University Faculty of Medicine, Department of Thoracic Surgery
0000-0001-7314-3131
Türkiye

Yayımlanma Tarihi 22 Eylül 2021
Başvuru Tarihi 10 Eylül 2021
Kabul Tarihi 13 Eylül 2021
Yayınlandığı Sayı Yıl 2021, Cilt 2, Sayı 3

Kaynak Göster

APA Çınar, E. , İnan, K. & Yildiz, O. O. (2021). Emergency major surgery in thoracic trauma: Timing and decision process . Archives of Current Medical Research , 2 (3) , 204-211 . Retrieved from https://dergipark.org.tr/tr/pub/acmr/issue/64942/993643

Archives of Current Medical Research (ACMR) provides instant open access to all content, bearing in mind the fact that presenting research

free to the public supports a greater global exchange of knowledge.

http://www.acmronline.org/