The National Trauma Data Bank story for emergency department thoracotomy: How old is too old? Surgery 2018 Mar;163(3):515-521
Date
02/06/2018Pubmed ID
29398037DOI
10.1016/j.surg.2017.12.011Scopus ID
2-s2.0-85041604705 (requires institutional sign-in at Scopus site) 12 CitationsAbstract
BACKGROUND: The fastest growing segment of the American population is the elderly (>65 years). This change in demographics also is being seen in trauma centers. Emergency department thoracotomy is utilized in an attempt to restore circulation for patients arriving in extremis. The purpose of this study was to investigate the relationship between clinical variables, particularly age, and outcomes for injured patients receiving an emergency department thoracotomy.
METHODS: Using the National Trauma Data Bank for years 2008-2012, observations with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for exploratory thoracotomy were identified. Emergency department thoracotomy was defined as any observation that occurred at a time to thoracotomy less than the total time spent in the emergency department thoracotomy, and within 15 minutes of arrival. Mechanisms of injury, demographic data, and injuries were analyzed for predictors of survival and mortality rates. Mortality rates were determined for each decade and year of life.
RESULTS: There were 11,380 observations for thoracotomy identified. Of these, 2,519 were emergency department thoracotomy, with the majority (n= 2,026, 80% observations) performed for penetrating wounds. Mortality rates ranged from 80% to 100% for each decade of life. Mortality was 100% for patients >57 years old with either penetrating or blunt mechanisms of injury.
CONCLUSION: Emergency department thoracotomy offered no survival benefit for patients older than 57 years of age. These data suggest that emergency department thoracotomy performed in elderly patients may be futile.
Author List
Gil LA, Anstadt MJ, Kothari AN, Javorski MJ, Gonzalez RP, Luchette FAAuthor
Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Age Factors
Aged
Aged, 80 and over
Child
Databases, Factual
Emergency Service, Hospital
Female
Humans
Injury Severity Score
Male
Middle Aged
Patient Selection
Retrospective Studies
Survival Rate
Thoracotomy
United States
Wounds, Nonpenetrating
Wounds, Penetrating
Young Adult