Penetrating chest wounds: 24 years experience

Abstract

Thoracic and thoracoabdominal penetrating wounds are frequently encountered in urban medical centers in the United States. This study was undertaken to determine the clinical characteristics and in hospital outcome of these injuries. This was a longitudinal, nonblinded study using the established standard of care of patients with penetrating chest trauma. It consists of an analysis of a consecutive series of 3049 patients treated at one trauma center between April 1972 and March 1996. There were 1347 stab wounds and 1702 gunshot wounds. Antibiotic prophylaxis was administered to patients who underwent laparotomy or thoracotomy or who had lung contusion with hemoptysis (41.6%, 1296/3049). Of 3049 patients, 196 had cardiac injuries. All of them underwent thoracotomy, and the mortality was 21.9%. In contrast, among 2853 patients without cardiac injuries, only 257 (9%) required thoracotomy; the mortality in this group was 1.5%. Patients with thoracoabdominal injuries (899/3049) had a mortality of 4.3% compared to 2.1% among those who had isolated chest injuries. The overall mortality was 2.8%. Of 1702 patients with gunshot wounds, 85 (5%) sustained transaxial injuries, with an overall mortality of 36.5%. The complication rate among the survivors was 6% with only 2.5% being infectious. We conclude that the mortality for noncardiac penetrating injuries of the chest is low. The presence of associated abdominal injuries increases the mortality twofold. More than one-third of the patients with transaxial wounds die. Gunshot wounds of the heart result in higher mortality than stab wounds to the heart. The infection rate is low.

Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands

“…This is because gunshot wounds are associated with more tissue destruction due to the high kinetic energy transfer. Tissue with lower specific gravity absorbs less kinetic energy, therefore the destruction and devitalisation in lung tissue is less than in other solids organs [2].…”

“…The incidence depends on regional circumstances like crime rates, therefore medical centers in urban areas deal in general more frequently with penetrating thoracic injury [2]. Early treatment of stab and gunshot wounds of the chest improves prognosis and outcome.…”

Thoracotomy in Thoracic Injuries: Results from a Tertiary Referral Hospital

“…Less than 10% of patients with blunt thoracic injury require a thoracotomy [3,9,10]. 9-19% of patients with a penetrating thoracic injury undergo thoracotomy [11,12]. In the current study, 3.8% of the patients with a thoracic injury underwent thoracotomy (1.4% of patients with blunt and 11.7% of patients with penetrating injuries).…”

Mortalidad Por Trauma Cardiaco Penetrante en Bogota, Colombia: Análisis de Factores Asociados

“…2 Estudios previos evidencian que uno de los segmentos corporales más frecuentemente comprometidos en trauma es el tórax, y que cerca del 6.4 % de los pacientes con PAJT trauma torácico presentan lesiones cardiacas, lo que señala la importancia que tienen estas lesiones en términos de frecuencia. 3 Se calcula una mortalidad entre 55-82% antes de recibir atención médica, y hasta un 85% a pesar de ingresar con signos vitales a un centro hospitalario. [4][5][6] Pero además de la mortalidad debemos considerar la frecuencia de posibles lesiones intracardiacas residuales, presentación calculada en 4% a 56% de los casos.…”