Societal Costs of Inappropriate Emergency Department Thoracotomy

Passos, Edward; Engels, Paul T.; Doyle, Jeffrey D.; Beckett, Andrew; Nascimento, Bartolomeu; Rizoli, Sandro; Tien, Homer

doi:10.1016/j.jamcollsurg.2011.09.020

Cited by 67 publications

(33 citation statements)

References 34 publications

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“…13 As previously mentioned, Passos et al reported on outcomes of EDTs at a large level 1 trauma centre in Toronto, Ontario. 11 The authors reported a survival rate of just 2.4% for 123 EDTs performed. 11 Our current data add to the growing body of literature on outcomes of EDTs at Canadian trauma centres.…”

Section: Discussionmentioning

confidence: 99%

“…Our study is an important one because there have been only three studies to date that describe the outcome of an EDT at Canadian trauma centres. [11][12][13] Karmy-Jones et al published data on penetrating cardiac injury in Edmonton over a 2-year period with only eight patients identified, of which three (38%) survived. 12 Six of these (75%) underwent an EDT, of which two (33.3%) survived.…”

Section: Discussionmentioning

confidence: 99%

“…A recent publication by Passos et al examined the performance of EDTs over a 17-year period at Sunnybrook Health Sciences Centre in Toronto, Ontario. 11 In total, 123 patients underwent an EDT with 3 patients surviving (2.4%). 11 Although four patients who received an EDT inappropriately made it to the operating room (OR), no patient survived when the EDT was performed outside of the previously mentioned indications.…”

Section: Introductionmentioning

confidence: 99%

“…11 In total, 123 patients underwent an EDT with 3 patients surviving (2.4%). 11 Although four patients who received an EDT inappropriately made it to the operating room (OR), no patient survived when the EDT was performed outside of the previously mentioned indications. 11 Given the paucity of data on outcomes of EDT in Canadian tertiary care trauma centres, the primary objective of this study was to define survival rates of EDT due to blunt and penetrating trauma at a Canadian regional trauma centre in Hamilton, Ontario.…”

Section: Introductionmentioning

confidence: 99%

“…11 Although four patients who received an EDT inappropriately made it to the operating room (OR), no patient survived when the EDT was performed outside of the previously mentioned indications. 11 Given the paucity of data on outcomes of EDT in Canadian tertiary care trauma centres, the primary objective of this study was to define survival rates of EDT due to blunt and penetrating trauma at a Canadian regional trauma centre in Hamilton, Ontario. In addition, as a secondary objective, we sought to evaluate the number of guideline compliant EDTs using the Western Trauma Association practice guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

Owen

Sne

Coates

et al. 2015

CJEM

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Objective: Emergency department thoracotomy (EDT) is a rare and potentially life-saving intervention performed for trauma patients in extremis. EDT is rare at Canadian trauma centres because of our infrequent occurrence of penetrating trauma. This study was undertaken to evaluate outcomes at a Canadian level 1 trauma facility and compare survival to large published datasets. Also, we evaluated the appropriateness of an EDT performed at our centre based on published national guidelines. Methods: Retrospective medical record review of all patients undergoing an EDT during their resuscitation in the emergency department. Records were identified using our trauma registry, and all charts were manually reviewed. The primary outcome was survival to hospital discharge. Results: Over a 20-year period, 58 EDTs were performed with 6 (10.3%) survivors. Patients undergoing an EDT secondary to penetrating trauma had the highest survival (5 of 24 patients or 20.8% survival) compared to patients undergoing an EDT for blunt trauma (1 of 34 patients or 2.9% survival). Patients undergoing an EDT who had not suffered cardiac arrest represented the group with the highest survival rate (3 of 6 patients or 50% survival). The majority of EDTs (79.3%) were indicated, and no patient undergoing an EDT survived if it was performed outside of published guidelines. Conclusions: Survival following an EDT in our small, regional trauma centre is consistent with survival rates from larger published datasets. An EDT should continue to be performed under accepted clinical indications. RÉSUMÉObjectifs: La thoracotomie pratiquée au service des urgences (TSU) est une intervention rare et potentiellement salvatrice chez les grands blessés qui arrivent dans un état gravissime au service des urgences (SU). La TSU est pratiquée rarement dans les centres de traumatologie en raison de la faible fréquence des traumas par pénétration. L'étude visait à évaluer les résultats de la TSU pratiquée dans un centre de traumatologie de niveau 1 au Canada et à comparer la survie à celle relevée dans de grands ensembles de données publiés. De plus, les auteurs voulaient évaluer la pertinence de la TSU pratiquée dans leur centre en fonction des lignes directrices nationales, publiées. Méthode: Il s'agit d'un examen rétrospectif des dossiers médicaux de tous les patients ayant subi une TSU durant les manoeuvres de réanimation au SU. La recherche des dossiers s'est faite à l'aide du registre des traumas de l'établissement concerné, et tous les dossiers ont fait l'objet d'un examen manuel. Le principal critère d'évaluation était la survie au moment de la sortie de l'hôpital. Résultats: Sur une période de 20 ans, 58 TSU ont été effectuées, dont 6 (10,3 %) se sont révélées fructueuses. Les patients ayant subi une TSU à la suite d'un trauma par pénétration ont connu le plus haut taux de survie (5 patients sur 24 ou taux de survie de 20,8 %) comparativement aux patients ayant subi une TSU à la suite d'un trauma contondant (1 patient sur 34 ou taux de survie de 2,9 %). ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

Owen

Sne

Coates

et al. 2015

CJEM

View full text Add to dashboard Cite

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Emergency Department Thoracotomy: Development of a Reliable, Validated Checklist for Procedural Training

Zaïdi

Dhake

Miller

et al. 2019

AEM Education and Training

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Objectives: Emergency department thoracotomy (EDT) is a rare and challenging procedure. Emergency medicine (EM) residents have limited opportunities to perform the procedure in clinical or educational settings. Standardized, reliable, validated checklists do not exist to evaluate procedural competency. The objectives of this project were twofold: 1) to develop a checklist containing the critical actions for performing an EDT that can be used for future procedural skills training and 2) to evaluate the reliability and validity of the checklist for performing EDT.Methods: After a literature review, a preliminary 22-item checklist was developed and disseminated to experts in EM and trauma surgery. A modified Delphi method was used to revise the checklist. To assess usability of the checklist, EM and trauma surgery faculty and residents were evaluated performing an EDT while inter-rater reliability was calculated with Cohen's kappa. A Student's t-test was used to compare the performance of participants who had or had not performed a thoracotomy in clinical practice. Item-total correlation was calculated for each checklist item to determine discriminatory ability.Results: A final 22-item checklist was developed for EDT. The overall inter-rater reliability was strong (j = 0.84) with individual item agreement ranging from moderate to strong (j = 0.61 to 1.00). Experts (attending physicians and senior residents) performed well on the checklist, achieving an average score of 80% on the checklist. Participants who had performed EDT in clinical practice performed significantly better than those that had not, achieving an average of 80.7% items completed versus 52.3% (p < 0.05). Seventeen of 22 items had an itemtotal correlation greater than 0.2. Conclusions:A final 22-item consensus-based checklist was developed for the EDT. Overall inter-rater reliability was strong. This checklist can be used in future studies to serve as a foundation for curriculum development around this important procedure.

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Predicting mortality in penetrating cardiac trauma in developing countries through a new classification: Validation of the Bogotá classification

Pulido

Reyes

Enríquez

et al. 2022

Health Science Reports

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Introduction Penetrating chest trauma (PCT) represents 10% of worldwide mortality, with developing countries counting as some of the most affected by high mortality rates due to cardiac trauma. Colombia is considered one of the most violent countries due to the high mortality rate associated with war and crime, hence the validation of an own classification for penetrating cardiac injuries (PCI) is mandatory. Methods Retrospective cross‐sectional study which included adult patients with PCIs at a level 4 trauma center in Colombia, between January 2018 and April 2020. We used our own system (Bogotá Classification) and compared it with traditional systems (e.g., Ivatury's, OIS‐AAST), by analyzing the mechanism of injury (MOI), the hemodynamic status of the patient at admission, the inpatient management, the individual outcomes, and some demographic variables. Bivariate statistical analysis, spearman correlation, and logistic regression were performed. Results Four hundred and ninety‐nine patients were included. Bivariate analysis demonstrated a significant relationship between mortality and hemodynamic state, MOI, its location and degree of lesion, cardiac/vessel injury, cardiac tamponade, time between injury and medical care, fluid reanimation, as well as the Ivatury's classification and the new classification (p < 0.005). The adequate correlation between Ivatury's and Bogotá classification supports the latter's clinical utility for patients presenting with PCI. Likewise, logistic regression showed a statistically significant association among mortality rates (p < 0.005). Conclusions The Bogotá classification showed similar performance to the Ivatury's classification, correlating most strongly with mortality. This scale could be replicated in countries with similar social and economic contexts.

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Societal Costs of Inappropriate Emergency Department Thoracotomy

Cited by 67 publications

References 34 publications

Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

Emergency Department Thoracotomy: Development of a Reliable, Validated Checklist for Procedural Training

Predicting mortality in penetrating cardiac trauma in developing countries through a new classification: Validation of the Bogotá classification

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