B. M. Dennis1, A. J. Medvecz2, O. L. Gunter1, O. D. Guillamondegui1 1Vanderbilt University Medical Center,Division Of Trauma And Surgical Critical Care,Nashville, TN, USA 2Vanderbilt University Medical Center,Department Of General Surgery,Nashville, TN, USA
Introduction: There continues to be significant debate in the trauma community regarding the indications for emergency department thoracotomy (EDT). Numerous studies have focused on the timing of EDT, while few have examined other factors that influence surgeon decision-making. We hypothesize there is continued variability among surgeons in the use of EDT.
Methods: A 13-question web-based survey was distributed to the membership of a large, national trauma association, examining demographics, trauma fellowship completion, trauma center designation, professional organization membership, and annual EDTs performed. Consideration of patient’s age, comorbidities, total injury burden and the use of technological adjuncts, such as ultrasound, was assessed. Respondents were asked when they would perform the procedure after loss of vital signs for blunt and penetrating trauma. Logistic regression determined factors influencing consideration of EDT.
Results: 540 of 1485 surveys were completed (36.4%). Patient age, total injury burden and comorbidities are considered by 38.5%, 29.1% and 55.7% of respondents, respectively. Technological adjuncts are used always or most of the time by 64% of respondents. 78% of respondents perform EDT with no more than 10 minutes of pre-hospital arrest for both blunt and penetrating traumatic arrest. 20.6% would never perform EDT for blunt traumatic arrest. Odds of EDT increase with longer pre-hospital times in both blunt and penetrating traumatic injuries as annual thoracotomies performed rise respectively (1.07, 95% CI 1.04-1.11; 1.09, 95% CI 1.0-1.13). Odds of performing an EDT with longer pre-hospital time in penetrating trauma decreases with increased respondent age (0.95, 95% CI 0.91-0.98).
Conclusion: Emergency department thoracotomy decision-making is more nuanced than previously described. Variation continues in the use of thoracotomy following loss of vital signs, in both blunt and penetrating trauma. For both mechanisms, there remains little consensus on the appropriate timing for performing EDT despite published guidelines. A large proportion of surgeons consider other factors such as patient age, total injury burden, and comorbidities in addition to vital signs when deciding to perform an EDT. Technological adjuncts are frequently used by surgeons to determine the need for EDT.