Penetrating chest trauma: A prospective study of prognostic factors for worse outcome after emergency surgery

Noha Helal; Hany  El-Rakhawy; Yousry Shaheen; Basem Mofreh; Fatma Fadl; Ahmed Sobhy

Noha Helal Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
Hany El-Rakhawy Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
Yousry Shaheen Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
Basem Mofreh Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
Fatma Fadl Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
Ahmed Sobhy Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt

Keywords: Penetrating chest trauma, Stab wound, Gunshot wound, Thoracotomy, Emergency surgery, Prognosis

Abstract

Background: Even though chest penetrating injuries are common as well as challenging to treat, most of the time they can be dealt without surgery. This study aimed to evaluate contemporary outcome following emergent surgical interventions for penetrating chest trauma and possible factors associated with poor prognosis.

Methods: This prospective study included 100 cases admitted to benha university hospital with either Stab Wound or Gunshot wound to the chest, with systolic blood pressure ≤90 mmHg and who underwent through Thoracotomy or sternotomy within duration of one hour of arrival.

Results: This study included 81 patients (77 stabbings, 4 gunshots) underwent a thoracotomy and 19 underwent median sternotomy within 60 minutes after the penetrating trauma, the mean period of surgery was 3 ±0.9, There were 94 male and 6 female cases and their mean age was 25 ±10.14 years, the mean Intensive care unit stay was 2 ±0.83 days in addition mean hospital stay was 6 ±1.06 days, the individuals who died had trauma at mid-clavicular line of the chest (100%) compared to survivors (5.5%), lesser systolic blood pressure on presentation in the emergency room (71 ±11 mmHg) equated with those who survived (90 ±9 mmHg, P<0.001) and lower hemoglobin level (6.4 ±0.5) compared with those who survived (8.4 ±1, P<0.001). As a whole, the mortality rate was 9% (n=9). individuals' Death Rates with stab wounds was 5/96 (5.2%) compared with 4/4 (100%) for patients with gunshot wounds. Right ventricular injury (P=0.03) was associated with mortality.

Conclusion: Early referral, within one hour, to emergency surgery results in acceptable postoperative mortality in patients with penetrating chest trauma. Anterior location of injury, initial hemodynamic instability, and gunshot wounds associated with poor prognosis.