Heridas torácicas: revisión de 90 casos

Zafra, J. Ruiz; Ramos, A. Sánchez-Palencia; Guevara, Antonio Cueto Ladrón de; Piña, J.M. Díez

doi:10.1016/s0300-2896(15)30304-5

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…In this retrospective Spanish study comprising 90 penetrating chest injuries, including 77 of stabbing, there were 29 (38%) superficial wounds [5]. In our study, we found that 40% of patients were discharged directly to their homes, which is comparable to the 38% of patients without surgery or chest drainage in the Spanish study [5].…”

Section: Discussionsupporting

confidence: 66%

“…This result shows a relatively high rate of overtriage in stable patients. Only one study has attempted to assess diagnosis in stable patients specifically [5]. In this retrospective Spanish study comprising 90 penetrating chest injuries, including 77 of stabbing, there were 29 (38%) superficial wounds [5].…”

Section: Discussionmentioning

confidence: 99%

“…In cases of chest stab trauma, the "penetrating trauma" may not have truly penetrated beyond the chest muscle wall and thus may not have caused organ injuries. In the context of stab and gunshot chest wounds, the older literature differentiated between effectively penetrating trauma and superficial trauma [4,5]. In more recent literature dealing with penetrating chest injuries, there is no classification differentiating actual invasive chest wounds and superficial wounds [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Admitting all patients with chest stab trauma in highlevel trauma centres may result in overtriage. In fact, some patients are discharged from the hospital a few hours after their admission [5,7]. Only 5 to 15% of patients require emergent cardiothoracic surgery [6,13], and overtriage is associated with work overload [14].…”

Section: Introductionmentioning

confidence: 99%

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Performance of pre-hospital evaluations in ruling out invasive chest stab wounds

Augustin

Guivarch

Pellenc

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background Some guidelines advocate for managing patients with penetrating thoracic wounds in trauma centres with cardiothoracic surgery. This systematic approach is questionable. Only 15% of these patients require surgery. It is known that clinical examination fails to detect hemopneumothorax in penetrating trauma. However, no studies have evaluated the combined diagnostic performance of vital signs and the clinical evaluation of wounds. The clinical characteristics of wounds have not been investigated. We aimed to evaluate the ability of combinations of pre-hospital signs to rule out invasive chest stab trauma. Methods This was a prospective observational study. All consecutive adult patients hospitalized in the perioperative acute care unit of a tertiary university hospital were included. Injury diagnoses were provided by exploratory surgery and imaging tests. Patients with a final diagnosis of invasive wounds (IWs) and patients with only superficial wounds were compared. Data regarding management and outcome were analysed. Results A total of 153 patients were included. After imaging or surgery, 58 (38%) patients were diagnosed with only superficial wounds, and 95 (62%) were diagnosed with thoracic or abdominal IWs. The false-negative rate of pre-hospital evaluations in the diagnosis of IWs was 42% [31–51]IQR25–75. In stable patients, pre-hospital data could not rule out IWs, with a negative predictive value of 58% and a positive predictive value of 70%. Twenty-nine (19%) patients required early emergent cardiothoracic surgery. Among these patients, 8 (28%) had no evidence of IWs in the pre-hospital period. Among the 59 patients without pre-hospital signs of IWs, 19 (33%) underwent at least one emergent procedure. Conclusions The combination of pre-hospital vital signs, visual evaluation of wounds, and physical examination failed to rule out IWs in patients with chest stab wounds. This implies that caution is needed in triage decision-making.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%