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  • Abstract talk

Validating dogma: Predictors of therapeutic thoracotomy after tube thoracostomy?

Ava Mokhtari
Houston, TX / US

Appointment

Date:
Time: –
Talk time:
Discussion time:
Location / Stream:
Room 1 (Auditorium)

Session

Best paper session

Topics

  • Polytrauma
  • Trauma and Emergency surgery | Miscellaneous

Authors

Ava Mokhtari (Houston, TX / US), Andrea Juarez (Houston, TX / US), Nicholas Maamari (Houston, TX / US), Jose Reyes (Houston, TX / US), Kristina Valdez (Houston, TX / US), Emma Burke (Houston, TX / US), Paulina Troung (Houston, TX / US), Martin Ziellinski (Houston, TX / US), Matthew Wall (Houston, TX / US), Kenneth Mattox (Houston, TX / US), Catherine Seger (Houston, TX / US)

Abstract

Introduction: The generally accepted cutoff to perform a therapeutic thoracotomy (TT) for traumatic thoracic hemorrhage is an immediate 1500 cc or more than 200 cc of blood loss per hour. These cutoffs were based off of surgeon observation and gestalt. Our goal was to determine a data-driven thresholds to guide decision making and to determine which patients are most likely to benefit from the decision to perform a TT.

Objectives: In the present study, we aimed to identify risk factors associated with the need for a TT following CT placement, and to characterize a potential correlation between initial CT output and need for TT.

Materials and Methods: A single center retrospective cohort study was conducted at an academic level I trauma center. Using an institutional trauma registry, all patients greater than 16 years of age requiring emergency department CT placement between January 2012 through December 2021 were identified. Patients were propensity score matched (PSM) based on age and sex at a 3:1 ratio to control for those not receiving TT. Univariate analysis was performed to assess for patient factors associated with the occurrence of TT and a regression analysis was performed to characterize the probability of a TT at different initial CT output volumes.

Results: 1686 patients met inclusion criteria. Following PSM, 180 patients were matched to the 60 patients who underwent TT. Multivariate analysis revealed initial CT output, systolic blood pressure, and chest AIS were highly correlated with the need for a TT (Table 1). For every 500 cc increase in CT output our model predicted a 5.3-fold greater likelihood of undergoing a TT, and a 1.3-fold increased probability of need for a TT for every 10 mmHg decrease in SBP.

Conclusion: Initial CT output, SBP, and hypotension all correlated with an increased likelihood of a TT. These three parameters must be considered when making the decision to perform a TT in patients with thoracic trauma.

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