L. Al-Khouja1, A. Grigorian1, S. Schubl1, K. Galvin1, A. Kong1, M. Lekawa1, T. Chin1, J. Nahmias1 1University Of California – Irvine,Department Of Trauma And Critical Care Surgery,Orange, CA, USA
Introduction: Thoracic trauma accounts for 20-25% of trauma deaths. Little is known about the injuries, mechanisms, and outcomes in trauma patients undergoing sternotomy for hemorrhage control. The purpose of this study is to perform a descriptive analysis of trauma patients undergoing sternotomy for hemorrhage control and identify which thoracic injuries and other factors are predictors of mortality. We hypothesize blunt trauma is associated with higher risk of death compared to penetrating trauma within this population.
Methods: The Trauma Quality Improvement Program (2010-2016) database was queried for patients undergoing sternotomy for hemorrhage control within 24-hours of admission. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U test. A multivariable logistic regression model was used to determine risk of mortality.
Results: Of the 584 patients undergoing sternotomy for hemorrhage control, 322 (55.1%) were involved in penetrating trauma, 69 (11.8%) in blunt trauma and 193 (33.3%) involved in “other/unknown” mechanism. The median injury severity score (ISS) was 25.0 and the most common known mechanism was a stab wound (49.9%) followed by gunshot wound (19.2%). The overall time to hemorrhage control was 52.8 minutes and was longer in those with blunt compared to penetrating trauma (84.6 vs. 49.8 minutes, p <0.001). Open-cardiac injury (26.4%) and hemothorax (23.5%) were the most common thoracic injuries. The most common procedures involved cardiac repair (44.7%) followed by lung repair (15.8%). The overall mortality rate was 18.2% and was higher in patients with blunt compared to penetrating trauma (29.0% vs. 12.7%, p<0.001). However, after adjusting for covariates there was no difference in risk of mortality between blunt and penetrating trauma (p=0.49). We did not find any independent predictors of mortality in patients with blunt trauma. The strongest independent predictor of mortality in patients with penetrating trauma was ISS≥25 (OR=6.24, CI=2.04-19.11, p=0.001).
Conclusion: Trauma patients who undergo sternotomy for bleeding often achieve hemorrhage control in less than one hour. Nearly half the patients present after a stab wound and require cardiac repair. Trauma patients requiring sternotomy for hemorrhage control after blunt trauma had a higher mortality rate, compared to those involved in penetrating trauma. However, after adjusting for known predictors of mortality in trauma, there was no difference in risk of mortality despite nearly double the time to hemorrhage control in patients presenting after blunt trauma.
