A selective non-operative approach to thoracic stab wounds is safe and cost effective – a South African experience

Introduction Penetrating thoracic trauma is common and costly. Injuries are frequently and selectively amenable to non-operative management. Our selective approach to penetrating thoracic trauma is reviewed and the effectiveness of our clinical algorithms confirmed. Additionally, a basic cost analysis was undertaken to evaluate the financial impact of a selective nonoperative management approach to penetrating thoracic trauma. Materials and methods The Pietermaritzburg Metropolitan Trauma Services electronic regional trauma registry hybrid electronic medical records were reviewed, highlighted all penetrating thoracic traumas. A micro-cost analysis estimated expenses for active observation, tube thoracostomy for isolated pneumothorax greater than 2 cm and tube thoracostomy for haemothorax. Routine thoracic computed tomography does not form part of these algorithms. Results Isolated thoracic stab wounds occurred in 589 patients. Eighty per cent (472 cases) were successfully managed nonoperatively. Micro-costing shows that active observation costs 4,370 ZAR (£270), tube thoracostomy for isolated pneumothorax costs 6,630 ZAR (£400) and tube thoracostomy for haemothorax costs 21,850 ZAR (£1,310). Discussion Penetrating thoracic trauma places a striking financial burden on our limited resources. Diligent and serial clinical assessments, alongside basic radiology and stringent management criteria, can accurately stratify patients to correct clinical algorithms. Conclusion Selective nonoperative management for penetrating thoracic trauma is safe and effective. Routine thoracic computed tomography is unnecessary in all patients with isolated thoracic stab wounds, which can be reserved for a select group who are identifiable clinically. Routine thoracic computed tomography would not be financially prudent across Pietermaritzburg Metropolitan Trauma Services. Government action is required to reduce the overall incidence of such trauma to save resources and patients.

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Utility of Chest Computed Tomography after a “Normal” Chest Radiograph in Patients with Thoracic Stab Wounds

The American Surgeon ◽

10.1177/000313481508101011 ◽

2015 ◽

Vol 81 (10) ◽

pp. 965-968 ◽

Cited By ~ 4

Author(s):

Brian M. Nguyen ◽

David Plurad ◽

Sadaf Abrishami ◽

Angela Neville ◽

Brant Putnam ◽

...

Keyword(s):

Computed Tomography ◽

Chest Radiograph ◽

Tube Thoracostomy ◽

Diagnostic Strategy ◽

Stab Wounds ◽

Chest Computed Tomography ◽

Future Studies ◽

Normal Chest Radiograph ◽

Normal Chest ◽

Level I

Chest computed tomography (CCT) is used to screen for injuries in hemodynamically stable patients with penetrating injury. We aim to determine the incidence of missed injuries detected on CCT after a negative chest radiograph (CXR) in patients with thoracic stab wounds. A 10-year retrospective review of a Level I trauma center registry was performed on patients with thoracic stab wounds. Patients who were hemodynamically unstable or did not undergo both CXR and CCT were excluded. Patients with a negative CXR were evaluated to determine if additional findings were diagnosed on CCT. Of 386 patients with stab wounds to the chest, 154 (40%) underwent both CXR and CCT. One hundred and fifteen (75%) had a negative screening CXR. CCT identified injuries in 42 patients (37%) that were not seen on CXR. Pneumothorax and/or hemothorax occurred in 40 patients (35%), of which 14 patients underwent tube thoracostomy. Two patients had hemopericardium on CCT and both required operative intervention. Greater than one-third of patients with a normal screening CXR were found to have abnormalities on CCT. Future studies comparing repeat CXR to CCT are required to further define the optimal diagnostic strategy in patients with stab wounds to chest after normal screening CXR.

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Selective Nonoperative Management of Anterior Abdominal Stab Wounds: 1992–2008

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31820b5eb7 ◽

2011 ◽

Vol 70 (2) ◽

pp. 408-414 ◽

Cited By ~ 19

Author(s):

Timothy P. Plackett ◽

Jonathan Fleurat ◽

Brad Putty ◽

Demetrios Demetriades ◽

David Plurad

Keyword(s):

Nonoperative Management ◽

Stab Wounds ◽

Selective Nonoperative Management ◽

Abdominal Stab Wounds

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Tomographic aspects of penetrating thoracic trauma: injuries from firearms and other weapons

Radiologia Brasileira ◽

10.1590/0100-3984.2016.0167 ◽

2017 ◽

Vol 50 (6) ◽

pp. 372-377 ◽

Cited By ~ 1

Author(s):

Alessandro Severo Alves de Melo ◽

Luiza Beatriz Melo Moreira ◽

Fernanda Miraldi Clemente Pessoa ◽

Nara Saint-Martin ◽

Roger Ancilotti Filho ◽

...

Keyword(s):

Computed Tomography ◽

Therapeutic Approach ◽

Thoracic Trauma ◽

Chest Trauma ◽

Gunshot Wounds ◽

Mediastinal Hematoma ◽

Pulmonary Lesions ◽

Risk Of Death ◽

Penetrating Chest Trauma ◽

Penetrating Thoracic Trauma

Abstract Objective: The aim of this study was to analyze the various computed tomography findings in penetrating chest trauma, as well as to determine the frequency and extent of the lesions. Material and Methods: We studied the computed tomography findings from 40 cases of penetrating thoracic trauma, of which 35 (85.8%) were gunshot wounds and 5 (14.2%) were caused by another type of weapon. Results: Pulmonary lesions were found in 39 cases (97.5%), manifesting as contusions in 34 cases (85%), atelectasis in 8 (20%), lacerations in 1 (2.5%) and hematomas in 1 (2.5%). Hemothorax was seen in 31 cases (77.5%), and pneumothorax was seen in 22 cases (55%). Mediastinal lesions were observed in 8 cases (20%), including mediastinal hematoma in 3 cases (7.5%), hemopericardium in 3 (7.5%), and pneumomediastinum in 2 (5%). Diaphragmatic rupture was seen in 2 cases (5%). Conclusion: In patients with penetrating thoracic trauma, computed tomography of the chest is an important tool for characterizing the affected organs and evaluating the path of injury, as well as the severity and extent of the lesions. The images obtained are also useful in estimating the risk of death and determining the best therapeutic approach.

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Thorax Gunshot and Sharp Cutting Tool Injuries: For 5 Months Nyala Experiences

Sudan Journal of Medical Sciences ◽

10.18502/sjms.v15i4.8164 ◽

2020 ◽

Author(s):

Hüseyin Fatih SEZER ◽

Hakan DAYANIR

Keyword(s):

Thoracic Trauma ◽

Cutting Tool ◽

Tube Thoracostomy ◽

Trauma Patients ◽

Thoracic Injuries ◽

Mortality And Morbidity ◽

Surgical Interventions ◽

Minimal Morbidity ◽

Penetrating Thoracic Trauma ◽

Post Traumatic

Background: The two most common causes of penetrating thoracic trauma are firearm injuries and injuries by sharpened cutting tool. Penetrating thoracic injuries are risk factors for high mortality and morbidity, so they need to be diagnosed correctly and timely in order to perform an effective intervention. In this study, patients with penetrating thoracic trauma were treated through surgical intervention accompanying minimal morbidity–mortality compared to literature, even though they were admitted relatively late. Methods: In this retrospective study, 29 gunshot and stab wounds penetrating thoracic trauma patients were admitted to the emergency department of Nyala Sudan Turkey Education and Research Hospital between April and September 2018. Results: Of the 29 patients, 7 (24.13%) were gunshot injuries and 22 (75.86%) were injured with a sharp cutting tool. While 13 of the cases (44.82%) were admitted on the day the incident took place, 5 of them (17.24%) were post-traumatic first day of the admission, 9 of them (31.03%) were post-traumatic day 2, whereas 1 of them (3.44%) was post-traumatic the third day of admission. Finally, 14 patients (48.28%) were followed-up conservatively without tube thoracostomy, while 15 patients (51.72%) underwent tube thoracostomy in follow-up. No patient was operated for penetrant trauma. Mortality was not seen. Conclusion: Patients with penetrating thoracic trauma were treated by surgical interventions accompanying minimal morbidity–mortality even though they were admitted relatively late to healthcare facilities. Key words: penetrating thoracic injuries, sharp cutting tool, gunshot

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