Reevaluate the indicatuions for thoracotomy based on chest tube output with severe blunt chest trauma

Abstract

We retrospectively analyzed 254 patients to determine the clinical strategy and indications for urgent thoracotomy in cases of blunt chest trauma (Chest AIS score ≥ 3). One hundred fifty-five (61%) of the 254 patients had multiple trauma injuries with other system injury of AIS score ≥ 3. Twenty-four patients (9.4%) required thoracotomy. Nineteen of the 24 patients showed more than one aspect of the “lethal triad” of metabolic acidosis, hypothermia, and coagulopathy, and 5 of the 24 patients showed all three aspects before surgery. Chest tube output of 14 patients who underwent thoracotomy for hemorrhage was less than the traditional amount used as an indication for urgent thoracotomy. Regarding thoracotomy, early-decision making is required for blunt chest trauma patients because of the multiple trauma and critical conditions. The traditional use of high chest tube output as an indicator for thoracotomy may not be applicable to patients with blunt chest trauma.