The National Trauma Data Bank story for emergency department thoracotomy: How old is too old?

Gil, Lindsay A.; Anstadt, Michael J.; Kothari, Anai N.; Javorski, Michael J.; Gonzalez, Richard P.; Luchette, Fred A.

doi:10.1016/j.surg.2017.12.011

Cited by 16 publications

(3 citation statements)

References 21 publications

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“…Clearly, the elderly have less physiological reserve and for any emergency surgery and trauma intervention one should carefully consider the balanced risk–benefit to avoid futility [35]. One US study found no survivors in patients >57 years of age who underwent emergency thoracotomy [36]. Of note, the two oldest survivors in the current series were 55 and 68 years, respectively.…”

Section: Discussionmentioning

confidence: 86%

Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time‐Critical, Low‐Volume Emergency Procedure Over Three Time Periods

et al. 2021

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Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.

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Section: Discussionmentioning

confidence: 86%

Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time‐Critical, Low‐Volume Emergency Procedure Over Three Time Periods

et al. 2021

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“…Although it has been well studied that outcome worsens with age, an altered immunologic response to severe trauma in the elderly patient may be the cause [ 17 , 28 , 29 ]. Emergency procedures that may reduce mortality in younger patients, such as thoracotomy, do not seem to improve outcomes in patients over 57 years of age, so that emergency surgery was performed less in the elderly in our study [ 30 ]. Nevertheless, van der Sluis et al clarified that they could not find any arguments against equal treatment of elderly compared with younger patients in their retrospective analysis [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Reality of treatment for severely injured patients: are there age-specific differences?

Maek,

Fochtmann,

Jungbluth

et al. 2024

BMC Emerg Med

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Background Major trauma and its consequences are one of the leading causes of death worldwide across all age groups. Few studies have conducted comparative age-specific investigations. It is well known that children respond differently to major trauma than elderly patients due to physiological differences. The aim of this study was to analyze the actual reality of treatment and outcomes by using a matched triplet analysis of severely injured patients of different age groups. Methods Data from the TraumaRegister DGU® were analyzed. A total of 56,115 patients met the following inclusion criteria: individuals with Maximum Abbreviated Injury Scale > 2 and < 6, primary admission, from German-speaking countries, and treated from 2011–2020. Furthermore, three age groups were defined (child: 3–15 years; adult: 20–50 years; and elderly: 70–90 years). The matched triplets were defined based on the following criteria: 1. exact injury severity of the body regions according to the Abbreviated Injury Scale (head, thorax, abdomen, extremities [including pelvis], and spine) and 2. level of the receiving hospital. Results A total of 2,590 matched triplets could be defined. Traffic accidents were the main cause of severe injury in younger patients (child: 59.2%; adult: 57.9%). In contrast, low falls (from < 3 m) were the most frequent cause of accidents in the elderly group (47.2%). Elderly patients were least likely to be resuscitated at the scene. Both children and elderly patients received fewer therapeutic interventions on average than adults. More elderly patients died during the clinical course, and their outcome was worse overall, whereas the children had the lowest mortality rate. Conclusions For the first time, a large patient population was used to demonstrate that both elderly patients and children may have received less invasive treatment compared with adults who were injured with exactly the same severity (with the outcomes of these two groups being opposite to each other). Future studies and recommendations should urgently consider the different age groups.

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“…These predictors were associated with favorable outcomes among patients who underwent EDT. However, no well-designed studies validated the obvious benefits of EDT than without EDT even in selected patients with such predictors 9 – 11 . Moreover, additional hemorrhage due to EDT procedures can reduce the chance of survival, and such potential harms have not been sufficiently examined.…”

Section: Introductionmentioning

confidence: 99%

Potential harms of emergency department thoracotomy in patients with persistent cardiac arrest following trauma: a nationwide observational study

Yamamoto,

Suzuki,

Sasaki

2023

Sci Rep

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Emergency department thoracotomy (EDT) was incorporated into traumatic out-of-hospital cardiac arrest (t-OHCA) resuscitation. Although current guidelines recommend EDT with survival predictors, futility following EDT has been demonstrated and the potential risks have not been thoroughly investigated. This study aimed to elucidate the benefits and harms of EDT for persistent cardiac arrest following injury until hospital arrival. This retrospective cohort study used a nationwide trauma registry (2019–2021) and included adult patients with t-OHCA both at the scene and on hospital arrival. Survival to discharge, hemostatic procedure frequency, and transfusion amount were compared between patients treated with and without EDT. Inverse probability weighting using a propensity score was conducted to adjust age, sex, comorbidities, mechanism of injury, prehospital resuscitative procedure, prehospital physician presence, presence of signs of life, degree of thoracic injury, transportation time, and institutional characteristics. Among 1289 patients, 374 underwent EDT. The longest transportation time for survivors was 8 and 23 min in patients with and without EDT, respectively. EDT was associated with lower survival to discharge (4/374 [1.1%] vs. 22/915 [2.4%]; adjusted odds ratio [OR], 0.43 [95% CI 0.22–0.84]; p = 0.011), although patients with EDT underwent more frequent hemostatic surgeries (46.0% vs. 5.0%; adjusted OR, 16.39 [95% CI 12.50–21.74]) and received a higher amount of transfusion. Subgroup analyses revealed no association between EDT and lower survival in patients with severe chest injuries (1.0% vs. 1.4%; adjusted OR, 0.72 [95% CI 0.28–1.84]). EDT was associated with lower survival till discharge in trauma patients with persistent cardiac arrests after adjusting for various patient backgrounds, including known indications for EDT. The idea that EDT is the last resort for t-OHCA should be reconsidered and EDT indications need to be deliberately determined.Trial registration This study is retrospectively registered at University Hospital Medical Information Network (UMIN ID: UMIN000050840).

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The National Trauma Data Bank story for emergency department thoracotomy: How old is too old?

Cited by 16 publications

References 21 publications

Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time‐Critical, Low‐Volume Emergency Procedure Over Three Time Periods

Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time‐Critical, Low‐Volume Emergency Procedure Over Three Time Periods

Reality of treatment for severely injured patients: are there age-specific differences?

Potential harms of emergency department thoracotomy in patients with persistent cardiac arrest following trauma: a nationwide observational study

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