Blunt Chest Trauma in Polytraumatized Patients: Predictive Factors for Urgent Thoracotomy.

ABSTRACT

PURPOSE: Current guidelines on urgent thoracotomy of polytraumatized patients are based on data from perforating chest injuries. We aimed to identify predictive factors for urgent thoracotomy after chest-tube placement for blunt chest trauma in a civilian setting. METHODS: Polytraumatized patients (Injury Severity Score ≥16) with blunt chest trauma, submitted to a level I trauma centre during a period of 12 years that received at least one chest tube were included. Trauma mechanism, chest-tube output, haemoglobin values, need for cellular blood products, coagulopathies, rib fracture pattern, thoracotomy, and mortality were retrospectively analysed. RESULTS: 235 polytraumatized patients were included. Patients that received urgent thoracotomy (UT, n = 10) showed a higher mean chest-tube output within 24 h with a median (Mdn) of 3865 (IQR 2423-5156) mL compared to the group with no additional thoracic surgery (NT, n = 225) with Mdn 185 (IQR 50-463) mL (p < 0.001). The cut-off 24-h chest-tube output value for recommended thoracotomy was 1270 mL (ROC-Curve). UT showed an initial haemoglobin of Mdn 11.7 (IQR 9.2-14.3) g/dL and an INR value of Mdn 1.27 (IQR 1.11-1.69) as opposed to Mdn 12.3 (IQR 10-13.9) g/dL and Mdn 1.13 (IQR 1.05-1.34) in NT (haemoglobin p = 0.786; INR p = 0.215). There was an average number of 7.1(±3.4) rib fractures in UT and 6.7(±4.8) in NT (p = 0.649). CONCLUSIONS: Chest-tube output remains the single most important predictive factor for urgent thoracotomy also after blunt chest trauma. Patients with a chest-tube output of more than 1300 mL within 24 h after trauma should be considered for transfer to a level I trauma centre with standby thoracic surgery.