• Jamie R Oliver, Charles J DiMaggio, Matthew L Duenes, Ana M Velez, Spiros G Frangos, Cherisse D Berry, and Marko Bukur.
• New York University School of Medicine, New York, New York.
• J Emerg Med. 2019 Dec 1; 57 (6): 765-771.

BackgroundEarly thoracotomy (ET) is a procedure performed on patients in extremis. Identifying factors associated with ET survival may allow for optimization of guidelines and improved patient selection.ObjectivesThe objective of this study was to assess whether ETs performed at Level I trauma centers (TC) are associated with improved survival.MethodsThis was a retrospective study utilizing the National Trauma Databank 2014-2015. We included all thoracotomies performed within 1 h of hospital arrival. Patients were stratified according to TC designation level. Patient demographics, outcomes, and center characteristics were compared. We conducted multivariable regression with survival as the outcome.ResultsThere were 3183 ETs included in this study; 2131 (66.9%) were performed at Level I TCs. Patients treated at Level I and non-Level I TCs had similar median injury severity scores, as well as signs of life and systolic blood pressures on admission. Patients treated at Level I TCs had significantly higher survival rates (21.6% vs. 16.3%, p < 0.001), with 40% greater odds of survival after controlling for injury-specific factors and emergency medical services transportation time (adjusted odds ratio 1.40, 95% confidence interval 1.04-1.89, p = 0.03). Penetrating injuries had 23.1% survival after ET vs. 12.9% for blunt injuries (adjusted odds ratio 1.86, 95% confidence interval 1.37-2.53, p < 0.001).ConclusionsETs performed at Level I TCs were associated with 40% greater odds of survival compared with ETs at non-Level I TCs. This demonstrates that factors extrinsic to the patient may play a role in survival of severely injured patients.Copyright © 2019 Elsevier Inc. All rights reserved.

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