Retrospective Analysis of Emergency Thoracotomy Outcomes in Patients with Blunt versus Penetrating Thoracic Trauma: A Comparative Study from a Tertiary Care Center (POF Hospital Wah Cantt)
DOI:
https://doi.org/10.53350/pjmhs02025199.4Keywords:
Emergency thoracotomy, blunt trauma, penetrating trauma, thoracic injury, trauma outcomes, retrospective study.Abstract
Background: Thoracic trauma is a major contributor to morbidity and mortality worldwide. Emergency thoracotomy (ET) is a critical, life-saving intervention for patients with severe chest trauma, but outcomes differ significantly depending on the mechanism of injuryblunt versus penetrating. This study retrospectively analyzes and compares the outcomes of ET performed at POF Hospital Wah Cantt.
Objective: To compare the clinical outcomes of emergency thoracotomy in patients with blunt versus penetrating thoracic injuries.
Methods: A retrospective study was conducted on patients who underwent emergency thoracotomy for chest trauma at POF Hospital Wah Cantt between January 2018 and December 2023. Patients were divided into two groups based on trauma type: blunt (Group A) and penetrating (Group B). Demographics, indications, intraoperative findings, complications, ICU stay, and survival rates were analyzed.
Results: A total of 62 patients were included (blunt: 28, penetrating: 34). The survival rate in Group B (penetrating) was significantly higher (41.2%) compared to Group A (21.4%). Blunt trauma cases had higher incidence of multi-organ injury and required prolonged ICU care. Common indications for ET were massive hemothorax, cardiac tamponade, and major vessel injury.
Conclusion: Penetrating thoracic injuries are more likely to benefit from emergency thoracotomy compared to blunt injuries. Mechanism of trauma should guide ET decisions. Early identification and surgical intervention, especially in penetrating injuries, can improve survival.
References
Selesner L, Yorkgitis B, Martin M, Ng G, Mukherjee K, Ignacio R, Freeman J, Wong LY, Durbin S, Crandall M, Longshore SW. Emergency department thoracotomy in children: A Pediatric Trauma Society, Western Trauma Association, and Eastern Association for the Surgery of Trauma systematic review and practice management guideline. Journal of Trauma and Acute Care Surgery. 2023 Sep 1;95(3):432-41.
Williams KY. Thoracoabdominal Trauma. Patient transport: principles and practice. E-book. 2023 Dec 18:282.
Miller DT, Zaidi HQ, Sista P, Dhake SS, Pirotte MJ, Fant AL, Salzman DH. Creation and implementation of a mastery learning curriculum for emergency department thoracotomy. Western Journal of Emergency Medicine. 2020 Aug 24;21(5):1258.
Fitch JL, Dieffenbaugher S, McNutt M, Miller CC, Wainwright DA, Villarreal JA, Wilson CT, Todd SR. Are we out of the woods yet? The aftermath of resuscitative thoracotomy. journal of surgical research. 2020 Jan 1;245:593-9.
Liu S, Ling L, Fu Y, Zhang WC, Zhang YH, Li Q, Zeng L, Hu J, Luo Y, Liu WJ. Survival predictor in emergency resuscitative thoracotomy for blunt trauma patients: Insights from a Chinese trauma center. Chinese Journal of Traumatology. 2024 Jul 27.
Hatchimonji JS, Seamon MJ. Emergency Department Thoracotomy in Penetrating Chest Trauma Patients with No Signs of Life: A Worthwhile Endeavor. World Journal of Surgery. 2023 Dec;47(12):3114-5.
Schulz-Drost S, Merschin D, Gümbel D, Matthes G, Hennig FF, Ekkernkamp A, Lefering R, Krinner S, TraumaRegister DGU. Emergency department thoracotomy of severely injured patients: an analysis of the TraumaRegister DGU®. European journal of trauma and emergency surgery. 2020 Jun;46(3):473-85.
Seamon MJ, Haut ER, Van Arendonk K, Barbosa RR, Chiu WC, Dente CJ, Fox N, Jawa RS, Khwaja K, Lee JK, Magnotti LJ. An evidence-based approach to patient selection for emergency department thoracotomy: a practice management guideline from the Eastern Association for the Surgery of Trauma. Journal of Trauma and Acute Care Surgery. 2015 Jul 1;79(1):159-73.
Blank JJ, Seamon MJ. Emergency Department Thoracotomy in Trauma. Current Surgery Reports. 2023 Apr;11(4):86-91.
Liu A, Nguyen J, Ehrlich H, Bisbee C, Santiesteban L, Santos R, McKenney M, Elkbuli A. Emergency resuscitative thoracotomy for civilian thoracic trauma in the field and emergency department settings: a systematic review and meta-analysis. Journal of Surgical Research. 2022 May 1;273:44-55.
Okonta KE, Amadi CE, Okoh PD, Ekwunife CN. Thoracotomy for chest trauma: Indication, operative finding, and outcome. Saudi Surgical Journal. 2020 Oct 1;8(4):180-4.
Hansen CK, Hosokawa PW, Mcintyre RC, McStay C, Ginde AA. A national study of emergency thoracotomy for trauma. Journal of emergencies, trauma, and shock. 2021 Jan 1;14(1):14-7.
Caputo G, Meda S, Piccioni A, Saviano A, Ojetti V, Savioli G, Piccini GB, Ferrari C, Voza A, Pellegrini L, Ottaviani M. Thoracic trauma: current approach in emergency medicine. Clinics and Practice. 2024 Sep 10;14(5):1869.
Niemann M, Graef F, Hahn F, Schilling EC, Maleitzke T, Tsitsilonis S, Stöckle U, Märdian S. Emergency thoracotomies in traumatic cardiac arrests following blunt trauma–experiences from a German level I trauma center. European Journal of Trauma and Emergency Surgery. 2023 Oct;49(5):2177-85.
Tucker H, Ramage L, Greenhalgh R, Griggs J, Lang N, Marsden M, Vulliamy P, Wohlgemut JM, Christian M, Davenport R. Trauma emergency thoracotomy for resuscitation in shock—a multi-centre evaluation of current UK practice of pre-hospital and emergency department resuscitative thoracotomy in trauma. Journal of Surgical Protocols and Research Methodologies. 2022 Oct;2022(4):snac011.
Sam AS, Nawijn F, Benders KE, Houwert RM, Leenen LP, Hietbrink F. Outcomes of the resuscitative and emergency thoracotomy at a Dutch level-one trauma center: are there predictive factors for survival?. European Journal of Trauma and Emergency Surgery. 2022 Dec;48(6):4877-87.
Liu A, Meizoso JP, Ray JJ, Namias N, Livingstone AS, Pizano LR, et al. Survival after emergency thoracotomy: a National Trauma Data Bank analysis. J Surg Res. 2022;273:44–55. https://doi.org/10.1016/j.jss.2021.11.012
Zangbar B, Rhee PM. Coagulopathy in the Trauma Patient. InAcute Care Surgery and Trauma 2023 Nov 3 (pp. 68-77). CRC Press.
Inaba K, Aksoy H, Seamon MJ, Lam L, McClure K, Derderian T, et al. Multicenter evaluation of the American College of Surgeons Trauma Quality Improvement Program's emergency department thoracotomy guidelines. J Trauma Acute Care Surg. 2013;74(1):157–163.
Almond P, Musters S, Meekings T, Nutbeam T, Lyon R, Lockey DJ. Pre hospitalresuscitative thoracotomy in medical cardiac arrest: outcomes and practical implications. Scand J Trauma Resusc Emerg Med. 2022;30:8.
Hromalik Jr LR, Wall Jr MJ, Mattox KL, Tsai PI. Penetrating cardiac injury: a narrative review. Mediastinum. 2023 Feb 22;7:15.
East Guidelines for Resuscitative Thoracotomy. J Trauma Acute Care Surg. 2015;79(3):427–432.
Matsushima K, Inaba K. Selective nonoperative management of abdominal gunshot wounds: What you need to know. Journal of Trauma and Acute Care Surgery. 2025 May 1;98(5):675-80.
Campbell JE, ed. International Trauma Life Support for Emergency Care Providers. Pearson Education; 2018.
Lasek J, Jadczuk E. Thoracic trauma–principals of surgical management. European Journal of Translational and Clinical Medicine. 2020 Mar 29;3(1):66-73.
Krammel M, Frimmel N, Hamp T, Grassmann D, Widhalm H, Verdonck P, Reisinger C, Sulzgruber P, Schnaubelt S. Outcomes and potential for improvement in the prehospital treatment of penetrating chest injuries in a European metropolitan area: A retrospective analysis of 2009–2017. Injury. 2024 Jan 1;55(1):110971.
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2025 ABDUL REHMAN SHAHID, MALIK MUHAMMAD KABIR, MUHAMMAD WALLEED KHAN, ARIBA REHAN, MUHAMMAD AKRAM, MUHAMMAD HASSAN
This work is licensed under a Creative Commons Attribution 4.0 International License.
