Triage and Outcome of Patients with Mediastinal Penetrating Trauma

Joshua H. Burack, Emad Kandil, Ahmed Sawas, Patricia A. O'Neill, Salvatore J A Sclafani, Robert C. Lowery, Michael E. Zenilman

Research output: Contribution to journalArticle

Abstract

Background: A retrospective study was conducted detailing an experience with echocardiography and contrast-enhanced helical computed tomographic angiographic (CTA) scans in the evaluation of stable patients with mediastinal penetrating trauma (MPT). Methods: Unstable patients underwent emergent operative intervention, and stable patients underwent chest roentgenogram, transthoracic echocardiography (TTE), and CTA. Further testing (angiogram, bronchoscopy, esophagoscopy, esophagogram) was done only if one of these studies revealed evidence of a trajectory in the vicinity of major vasculature or viscera. Results: Between 1997 and 2003, 207 patients had MPT. Seventy-two (35%) were unstable (45 gun shot wounds, 27 stab wounds) and 19 died in the emergency department. Fifty-three had emergent intervention and 32 survived. Work-up was done on 135 stable patients (65%) consisting of 46 gunshot wounds and 89 stab wounds, of which 5 had a positive TTE result and underwent a repair of a cardiac injury. CTA evaluation was normal in almost 80% of patients, who subsequently did not require further evaluation or treatment. In the stable patients, endoscopy or esophagography confirmed one tracheal injury and no esophageal injury. In the entire group, 10 patients (7%) had occult injury, and there were no deaths or missed injuries. Conclusions: In cases of MPT, unstable patients require surgery, and in stable patients, TTE and chest CTA are effective screening tools. Patients with a negative TTE and CTA results can be observed and may not require further testing or endoscopy, whereas patients with positive TTE or CTA results require further assessment to exclude occult injury.

Original languageEnglish (US)
Pages (from-to)377-382
Number of pages6
JournalAnnals of Thoracic Surgery
Volume83
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

Fingerprint

Triage
Wounds and Injuries
Echocardiography
Stab Wounds
Endoscopy
Thorax
Esophagoscopy
Gunshot Wounds
Viscera
Firearms
Bronchoscopy
Hospital Emergency Service
Angiography
Retrospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Burack, J. H., Kandil, E., Sawas, A., O'Neill, P. A., Sclafani, S. J. A., Lowery, R. C., & Zenilman, M. E. (2007). Triage and Outcome of Patients with Mediastinal Penetrating Trauma. Annals of Thoracic Surgery, 83(2), 377-382. https://doi.org/10.1016/j.athoracsur.2006.05.107

Triage and Outcome of Patients with Mediastinal Penetrating Trauma. / Burack, Joshua H.; Kandil, Emad; Sawas, Ahmed; O'Neill, Patricia A.; Sclafani, Salvatore J A; Lowery, Robert C.; Zenilman, Michael E.

In: Annals of Thoracic Surgery, Vol. 83, No. 2, 02.2007, p. 377-382.

Research output: Contribution to journalArticle

Burack, JH, Kandil, E, Sawas, A, O'Neill, PA, Sclafani, SJA, Lowery, RC & Zenilman, ME 2007, 'Triage and Outcome of Patients with Mediastinal Penetrating Trauma', Annals of Thoracic Surgery, vol. 83, no. 2, pp. 377-382. https://doi.org/10.1016/j.athoracsur.2006.05.107
Burack JH, Kandil E, Sawas A, O'Neill PA, Sclafani SJA, Lowery RC et al. Triage and Outcome of Patients with Mediastinal Penetrating Trauma. Annals of Thoracic Surgery. 2007 Feb;83(2):377-382. https://doi.org/10.1016/j.athoracsur.2006.05.107
Burack, Joshua H. ; Kandil, Emad ; Sawas, Ahmed ; O'Neill, Patricia A. ; Sclafani, Salvatore J A ; Lowery, Robert C. ; Zenilman, Michael E. / Triage and Outcome of Patients with Mediastinal Penetrating Trauma. In: Annals of Thoracic Surgery. 2007 ; Vol. 83, No. 2. pp. 377-382.
@article{ca285f1e8fd04c5587cff56a9f7c1cfb,
title = "Triage and Outcome of Patients with Mediastinal Penetrating Trauma",
abstract = "Background: A retrospective study was conducted detailing an experience with echocardiography and contrast-enhanced helical computed tomographic angiographic (CTA) scans in the evaluation of stable patients with mediastinal penetrating trauma (MPT). Methods: Unstable patients underwent emergent operative intervention, and stable patients underwent chest roentgenogram, transthoracic echocardiography (TTE), and CTA. Further testing (angiogram, bronchoscopy, esophagoscopy, esophagogram) was done only if one of these studies revealed evidence of a trajectory in the vicinity of major vasculature or viscera. Results: Between 1997 and 2003, 207 patients had MPT. Seventy-two (35{\%}) were unstable (45 gun shot wounds, 27 stab wounds) and 19 died in the emergency department. Fifty-three had emergent intervention and 32 survived. Work-up was done on 135 stable patients (65{\%}) consisting of 46 gunshot wounds and 89 stab wounds, of which 5 had a positive TTE result and underwent a repair of a cardiac injury. CTA evaluation was normal in almost 80{\%} of patients, who subsequently did not require further evaluation or treatment. In the stable patients, endoscopy or esophagography confirmed one tracheal injury and no esophageal injury. In the entire group, 10 patients (7{\%}) had occult injury, and there were no deaths or missed injuries. Conclusions: In cases of MPT, unstable patients require surgery, and in stable patients, TTE and chest CTA are effective screening tools. Patients with a negative TTE and CTA results can be observed and may not require further testing or endoscopy, whereas patients with positive TTE or CTA results require further assessment to exclude occult injury.",
author = "Burack, {Joshua H.} and Emad Kandil and Ahmed Sawas and O'Neill, {Patricia A.} and Sclafani, {Salvatore J A} and Lowery, {Robert C.} and Zenilman, {Michael E.}",
year = "2007",
month = "2",
doi = "10.1016/j.athoracsur.2006.05.107",
language = "English (US)",
volume = "83",
pages = "377--382",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - Triage and Outcome of Patients with Mediastinal Penetrating Trauma

AU - Burack, Joshua H.

AU - Kandil, Emad

AU - Sawas, Ahmed

AU - O'Neill, Patricia A.

AU - Sclafani, Salvatore J A

AU - Lowery, Robert C.

AU - Zenilman, Michael E.

PY - 2007/2

Y1 - 2007/2

N2 - Background: A retrospective study was conducted detailing an experience with echocardiography and contrast-enhanced helical computed tomographic angiographic (CTA) scans in the evaluation of stable patients with mediastinal penetrating trauma (MPT). Methods: Unstable patients underwent emergent operative intervention, and stable patients underwent chest roentgenogram, transthoracic echocardiography (TTE), and CTA. Further testing (angiogram, bronchoscopy, esophagoscopy, esophagogram) was done only if one of these studies revealed evidence of a trajectory in the vicinity of major vasculature or viscera. Results: Between 1997 and 2003, 207 patients had MPT. Seventy-two (35%) were unstable (45 gun shot wounds, 27 stab wounds) and 19 died in the emergency department. Fifty-three had emergent intervention and 32 survived. Work-up was done on 135 stable patients (65%) consisting of 46 gunshot wounds and 89 stab wounds, of which 5 had a positive TTE result and underwent a repair of a cardiac injury. CTA evaluation was normal in almost 80% of patients, who subsequently did not require further evaluation or treatment. In the stable patients, endoscopy or esophagography confirmed one tracheal injury and no esophageal injury. In the entire group, 10 patients (7%) had occult injury, and there were no deaths or missed injuries. Conclusions: In cases of MPT, unstable patients require surgery, and in stable patients, TTE and chest CTA are effective screening tools. Patients with a negative TTE and CTA results can be observed and may not require further testing or endoscopy, whereas patients with positive TTE or CTA results require further assessment to exclude occult injury.

AB - Background: A retrospective study was conducted detailing an experience with echocardiography and contrast-enhanced helical computed tomographic angiographic (CTA) scans in the evaluation of stable patients with mediastinal penetrating trauma (MPT). Methods: Unstable patients underwent emergent operative intervention, and stable patients underwent chest roentgenogram, transthoracic echocardiography (TTE), and CTA. Further testing (angiogram, bronchoscopy, esophagoscopy, esophagogram) was done only if one of these studies revealed evidence of a trajectory in the vicinity of major vasculature or viscera. Results: Between 1997 and 2003, 207 patients had MPT. Seventy-two (35%) were unstable (45 gun shot wounds, 27 stab wounds) and 19 died in the emergency department. Fifty-three had emergent intervention and 32 survived. Work-up was done on 135 stable patients (65%) consisting of 46 gunshot wounds and 89 stab wounds, of which 5 had a positive TTE result and underwent a repair of a cardiac injury. CTA evaluation was normal in almost 80% of patients, who subsequently did not require further evaluation or treatment. In the stable patients, endoscopy or esophagography confirmed one tracheal injury and no esophageal injury. In the entire group, 10 patients (7%) had occult injury, and there were no deaths or missed injuries. Conclusions: In cases of MPT, unstable patients require surgery, and in stable patients, TTE and chest CTA are effective screening tools. Patients with a negative TTE and CTA results can be observed and may not require further testing or endoscopy, whereas patients with positive TTE or CTA results require further assessment to exclude occult injury.

UR - http://www.scopus.com/inward/record.url?scp=33846378067&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846378067&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2006.05.107

DO - 10.1016/j.athoracsur.2006.05.107

M3 - Article

C2 - 17257952

AN - SCOPUS:33846378067

VL - 83

SP - 377

EP - 382

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 2

ER -