TY  - JOUR
T1  - THe double jeopardy of blunt thoracoabdominal trauma
AU  - Berg RJ, Okoye O, Teixeira PG, Inaba K, Demetriades D
Y1  - 2012/06/01
N1  - 10.1001/archsurg.2011.2289
JO  - Archives of Surgery
SP  - 498
EP  - 504
VL  - 147
IS  - 6
N2  - Objectives 
                  To examine the specific injuries, need for operative intervention, and clinical outcomes of patients with blunt thoracoabdominal trauma.Design 
                  Trauma registry and medical record review.Setting 
                  Level I trauma center in Los Angeles, California.Patients 
                  All patients with thoracoabdominal injuries from January 1996 to December 2010.Main Outcome Measures 
                  Injuries, incidence and type of operative intervention, clinical outcomes, and risk factors for mortality.Results 
                  Blunt thoracoabdominal injury occurred in 1661 patients. Overall, 474 (28.5%) required laparotomy, 31 (1.9%) required thoracotomy (excluding resuscitative thoracotomy), and 1146 (69.0%) required no thoracic or abdominal operation. Overall incidence of intra-abdominal solid organ injury was 59.7% and hollow viscus injury, 6.0%. Blunt cardiac trauma occurred in 6.3%; major thoracic vessel injury, in 4.6%; and diaphragmatic trauma, in 6.0%. The majority of solid organ injuries were managed nonoperatively (liver, 83.9%; spleen, 68.3%; and kidney, 91.2%). Excluding patients with severe head trauma, mortality ranged from 4.5% with nonoperative management to 18.1% and 66.7% in those requiring laparotomy and dual cavitary exploration, respectively. Age 55 years or older, Injury Severity Score of 25 or more, Glasgow Coma Scale score of 8 or less, initial hypotension, massive transfusion, and liver, cardiac, or abdominal vascular trauma were all independent risk factors for mortality.Conclusions 
                  Most patients with blunt thoracoabdominal trauma are managed nonoperatively. The need for nonresuscitative thoracotomy or combined thoracoabdominal operation is rare. The abdomen contains the overwhelming majority of injuries requiring operative intervention and should be the initial cavity of exploration in the patient requiring emergent surgery without directive radiologic data.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2011.2289
UR  - http://dx.doi.org/10.1001/archsurg.2011.2289
ER  -