• Regan J Berg, Obi Okoye, Pedro G Teixeira, Kenji Inaba, and Demetrios Demetriades.
• Division of Trauma Surgery and Surgical Critical Care, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA 90033, USA.
• Arch Surg. 2012 Jun 1; 147 (6): 498-504.

ObjectivesTo examine the specific injuries, need for operative intervention, and clinical outcomes of patients with blunt thoracoabdominal trauma.DesignTrauma registry and medical record review.SettingLevel I trauma center in Los Angeles, California.PatientsAll patients with thoracoabdominal injuries from January 1996 to December 2010.Main Outcome MeasuresInjuries, incidence and type of operative intervention, clinical outcomes, and risk factors for mortality.ResultsBlunt thoracoabdominal injury occurred in 1661 patients. Overall, 474 (28.5%) required laparotomy, 31 (1.9%) required thoracotomy (excluding resuscitative thoracotomy), and 1146 (69.0%) required no thoracic or abdominal operation. Overall incidence of intraabdominal solid organ injury was 59.7% and hollow viscus injury, 6.0%. Blunt cardiac trauma occurred in 6.3%; major thoracic vessel injury, in 4.6%; and diaphragmatic trauma, in 6.0%. The majority of solid organ injuries were managed nonoperatively (liver, 83.9%; spleen, 68.3%; and kidney, 91.2%). Excluding patients with severe head trauma, mortality ranged from 4.5% with nonoperative management to 18.1% and 66.7% in those requiring laparotomy and dual cavitary exploration, respectively. Age 55 years or older, Injury Severity Score of 25 or more, Glasgow Coma Scale score of 8 or less, initial hypotension, massive transfusion, and liver, cardiac, or abdominal vascular trauma were all independent risk factors for mortality.ConclusionsMost patients with blunt thoracoabdominal trauma are managed nonoperatively. The need for non-resuscitative thoracotomy or combined thoracoabdominal operation is rare. The abdomen contains the overwhelming majority of injuries requiring operative intervention and should be the initial cavity of exploration in the patient requiring emergent surgery without directive radiologic data.

37 keywords...

hide…