Skip to main content

Advertisement

SpringerLink
Log in

Impact of Aggressive Treatments in Trauma: Using the Emergent Department Thoracotomy to Death Ratio

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

The emergency department thoracotomy remains controversial. We sought to explore the correlation between trauma center practices with regard to emergency department thoracotomy performance and survival of patients admitted to these centers. We hypothesized that centers that perform emergency department thoracotomies liberally would not necessarily have increased survival. Level I and II trauma centers contributing data to the National Trauma Data Bank between 2007 and 2011 were included. The data were aggregated and the counts for emergency department thoracotomies and emergency department deaths were calculated for each center. Centers were then divided into quartiles based on the emergency department thoracotomies:emergency department deaths ratio. A multivariate logistic regression model was utilized to calculate the adjusted odds ratio for mortality. The primary outcome was overall mortality. A total of 174 trauma centers admitting 1,432,811 subjects were included. The median EDT:EDD ratio ranged from 0 for Q1 to 17.6% for centers in the highest quartile (Q4). Q4 centers were more likely to be level I (Q4: 67.4% vs. Q1: 44.2%, p = 0.03) and an academic center (Q4: 67.4% vs. Q1: 41.9%, p = 0.05). Compared to patients admitted to Q1 centers, those admitted to Q4 centers had a higher adjusted mortality (adjusted odds ratio: 1.1, 95% CI 1.02–1.10, adjusted p < 0.01). Trauma centers where emergency department thoracotomies are liberally performed had a higher adjusted mortality. Further investigation is required to identify areas for improvement and standardization of the management of the trauma patient in extremis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. DiGiacomo JC, Angus LDG (2017) Thoracotomy in the emergency department for resuscitation of the mortally injured. Chin J Traumatol 20(3):141–146

    Article  PubMed  PubMed Central  Google Scholar 

  2. Cothren CC, Moore EE (2006) Emergency department thoracotomy for the critically injured patient: objectives, indications, and outcomes. World J Emerg Surg 1:4

    Article  PubMed  PubMed Central  Google Scholar 

  3. Burlew CC, Moore EE, Moore FA et al (2012) Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg 73(6):1359–1363

    Article  PubMed  Google Scholar 

  4. Passos EM, Engels PT, Doyle JD et al (2012) Societal costs of inappropriate emergency department thoracotomy. J Am Coll Surg 214(1):18–25

    Article  PubMed  Google Scholar 

  5. Kaplan AJ, Zone-Smith LK, Hannegan C, Norcross ED (1992) The prevalence of hepatitis C in a regional level I trauma center population. J Trauma 33(1):126–128; discussion 128–129.

  6. Nunn A, Prakash P, Inaba K et al (2018) Occupational exposure during emergency department thoracotomy: a prospective, multi-institution study. J Trauma Acute Care Surg 85(1):78–84

    Article  PubMed  Google Scholar 

  7. Barmparas G, Ko A, Dhillon NK et al (2017) Extreme interventions for trauma patients in extremis: variations among trauma centers. Am Surg 83(10):1033–1039

    Article  PubMed  Google Scholar 

  8. Cox DM (1928) Wounds of the heart: report of two cases. Arch Surg 17(3):484–492

    Article  Google Scholar 

  9. D’Souza RS, Law L. Open heart massage. In: StatPearls. StatPearls Publishing; 2020. Accessed August 16, 2020. http://www.ncbi.nlm.nih.gov/books/NBK537230/

  10. Beall AC, Diethrich EB, Crawford HW, Cooley DA, De Bakey ME (1966) Surgical management of penetrating cardiac injuries. Am J Surg 112(5):686–692

    Article  PubMed  Google Scholar 

  11. Brenner M, Inaba K, Aiolfi A et al (2018) Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy in select patients with hemorrhagic shock: early results from the American Association for the Surgery of Trauma’s Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry. J Am Coll Surg 226(5):730–740

    Article  PubMed  Google Scholar 

  12. Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N (2000) Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg 190(3):288–298

    Article  CAS  PubMed  Google Scholar 

  13. Feliciano DV, Bitondo CG, Cruse PA et al (1986) Liberal use of emergency center thoracotomy. Am J Surg 152(6):654–659

    Article  CAS  PubMed  Google Scholar 

  14. Seamon MJ, Haut ER, Van Arendonk K et al (2015) An evidence-based approach to patient selection for emergency department thoracotomy: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 79(1):159–173

    Article  PubMed  Google Scholar 

  15. Miglietta MA, Robb TV, Eachempati SR et al (2001) Current opinion regarding indications for emergency department thoracotomy. J Trauma 51(4):670–676

    Article  CAS  PubMed  Google Scholar 

  16. Schnüriger B, Inaba K, Branco BC et al (2010) Organ donation: an important outcome after resuscitative thoracotomy. J Am Coll Surg 211(4):450–455

    Article  PubMed  Google Scholar 

  17. Bulger EM, Nathens AB, Rivara FP et al (2002) Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 30(8):1870–1876

    Article  PubMed  Google Scholar 

  18. Zafar SN, Shah AA, Zogg CK et al (2016) Morbidity or mortality? Variations in trauma centres in the rescue of older injured patients. Injury 47(5):1091–1097

    Article  PubMed  Google Scholar 

  19. Akhmerov A, Huang R, Carlson K et al (2020) Access to extracorporeal life support as a quality metric: Lessons from trauma. J Card Surg 35(4):826–830

    Article  PubMed  Google Scholar 

  20. Nathens AB, Rivara FP, Mack CD et al (2006) Variations in rates of tracheostomy in the critically ill trauma patient. Crit Care Med 34(12):2919–2924

    Article  PubMed  Google Scholar 

  21. Carlson KA, Dhillon NK, Patel KA, et al. Utilization of tracheostomy among geriatric trauma patients and association with mortality. Eur J Trauma Emerg Surg. Published online August 8, 2019.

  22. Scalea TM, Bochicchio KM, Lumpkins K et al (2008) Early aggressive use of fresh frozen plasma does not improve outcome in critically injured trauma patients. Ann Surg 248(4):578–584

    Article  PubMed  Google Scholar 

  23. Wade CE, del Junco DJ, Holcomb JB et al (2011) Variations between level I trauma centers in 24-hour mortality in severely injured patients requiring a massive transfusion. J Trauma 71(2 Suppl 3):S389-393

    PubMed  Google Scholar 

  24. Barmparas G, Dhillon NK, Smith EJ et al (2018) Patterns of vasopressor utilization during the resuscitation of massively transfused trauma patients. Injury 49(1):8–14

    Article  PubMed  Google Scholar 

  25. Boudreau RM, O’Neal E, Besl KM et al (2019) Do autopsies still matter? The influence of autopsy data on final Injury Severity Score calculations. J Surg Res 233:453–458

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Navpreet K. Dhillon, Deven C. Patel, Raymond Huang, Audrey R. Yang, Harveen K. Sekhon, Daniel R. Margulies, Eric J. Ley & Galinos Barmparas

Authors
  1. Navpreet K. Dhillon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deven C. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raymond Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Audrey R. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harveen K. Sekhon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel R. Margulies
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eric J. Ley
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Galinos Barmparas
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conceptions and design: Dhillon, Barmparas; analysis and interpretation of data: Dhillon, Patel, Yang, Sekhon, Huang, Barmparas; literature review: Dhillon, Patel, Yang, Sekhon, Huang; drafting of manuscript: Dhillon, Patel, Barmparas; critical revision: Margulies, Ley, Barmparas.

Corresponding author

Correspondence to Galinos Barmparas.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This manuscript was a quickshot presentation on January 31, 2018, at the 13th annual meeting of the Academic Surgical Congress in Jacksonville, FL.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dhillon, N.K., Patel, D.C., Huang, R. et al. Impact of Aggressive Treatments in Trauma: Using the Emergent Department Thoracotomy to Death Ratio. Indian J Surg 85, 295–300 (2023). https://doi.org/10.1007/s12262-022-03392-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-022-03392-6

Keywords

Search

Navigation