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Ann Thorac Surg 2007;83:377-382
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Triage and Outcome of Patients with Mediastinal Penetrating Trauma

^a Department of Surgery, Kings County Hospital Center, and State University of New York–Downstate, Brooklyn, New York
^b Department of Radiology, Kings County Hospital Center, and State University of New York–Downstate, Brooklyn, New York

Accepted for publication May 18, 2006.

^_* Address correspondence to Dr Burack, Department of Surgery, Box 40, State University of New York–Downstate, 450 Clarkson Ave, Brooklyn, NY 11203. (Email: jburack{at}downstate.edu).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: A retrospective study was conducted detailing an experience with echocardiography and contrast-enhanced helical computed tomographic angiographic (CTA) scans in the evaluation of stable patients with mediastinal penetrating trauma (MPT).

METHODS: Unstable patients underwent emergent operative intervention, and stable patients underwent chest roentgenogram, transthoracic echocardiography (TTE), and CTA. Further testing (angiogram, bronchoscopy, esophagoscopy, esophagogram) was done only if one of these studies revealed evidence of a trajectory in the vicinity of major vasculature or viscera.

RESULTS: Between 1997 and 2003, 207 patients had MPT. Seventy-two (35%) were unstable (45 gun shot wounds, 27 stab wounds) and 19 died in the emergency department. Fifty-three had emergent intervention and 32 survived. Work-up was done on 135 stable patients (65%) consisting of 46 gunshot wounds and 89 stab wounds, of which 5 had a positive TTE result and underwent a repair of a cardiac injury. CTA evaluation was normal in almost 80% of patients, who subsequently did not require further evaluation or treatment. In the stable patients, endoscopy or esophagography confirmed one tracheal injury and no esophageal injury. In the entire group, 10 patients (7%) had occult injury, and there were no deaths or missed injuries.

CONCLUSIONS: In cases of MPT, unstable patients require surgery, and in stable patients, TTE and chest CTA are effective screening tools. Patients with a negative TTE and CTA results can be observed and may not require further testing or endoscopy, whereas patients with positive TTE or CTA results require further assessment to exclude occult injury.

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Invited commentary

Kenneth Mattox
Ann. Thorac. Surg. 2007 83: 382. [Extract] [Full Text] [PDF]

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				K. Mattox Invited commentary Ann. Thorac. Surg., February 1, 2007; 83(2): 382 - 382. [Full Text] [PDF]