Clinical Patterns of Penetrating Torso Injury at Emergency Department

응급실을 통하여 입원한 체간부 관통상 환자에 관한 임상적인 고찰

  • Yun, Soon Young (Department of Emergency Medicine, College of Medicine, Ewha Womans University) ;
  • Cheon, Young Jin (Department of Emergency Medicine, College of Medicine, Ewha Womans University) ;
  • Won, Tae Hee (Department of Cardiothoracic Surgery, College of Medicine, Ewha Womans University)
  • 윤순영 (이화여자대학교 응급의학교실) ;
  • 전영진 (이화여자대학교 응급의학교실) ;
  • 원태희 (이화여자대학교 흉부외과학교실)
  • Received : 2005.05.23
  • Accepted : 2005.06.14
  • Published : 2005.06.30

Abstract

Background: This study was undertaken to evaluate the clinical pattern of the patients with penetrating torso injury. We retrospectively analyzed the clinical symptoms, mechanism of injury, injury type including injured organ, and ultimate outcome of treatment. Our purpose of the study was to establish guideline of management in penetrating torso injury. Methods: This study consists of an analysis of a consecutive series of 94 patients with penetrating injury of trunk treated at one general hospital during 7year period (from January 1995 to April 2003) who was admitted through in our emergency department. All data were collected from the medical records and entered in a database for analysis on the following: age, sex, mechanism of injury, vital sign at admission, clinical outcome including hospital mortality, length of hospital stay, length of intensive care unit stay, requirement of crystalloid fluid and blood product. Results: Among 94 patients, there were 68 men and 26 women, with ages ranging from 19 to 82 years (average 38.2 years). The most frequent mechanism of injury was violence by others including rob (n=54, 57.4%) followed by suicidal attempt (n=24, 25.5%) and accidental injury (n=16, 17.0%). No injury was inflicted from gun. In 37 patients, systolic blood pressure at admission was under 90mmHg. The time interval from injury to admission, and from admission to operation was 57.8minutes and 4hour 12minutes each. Laparotomy was required in 70 patients, thoracotomy in 5 patients, and 3 patients required thoracotomy and laparotomy. Among 94 patients, an average of 1.7 organs were injured. The small bowel and colon were the organs most commonly wounded followed by liver, mesentery, pleura. Of the 94 patients, 6 died for an overall mortality rate of 6.4%, and two of them were not related with hemorrhage. The average length of hospital stay was 18.1 days, and 40 patients required ICU care. Conclusion: Of the 94 patients who were admitted from penetrating torso injury, no patient was injured from firearm. Overall mortality rate was 6.4%. In our hospital, firearm injury was relative rare.

Keywords

References

  1. Zakharia AT. Thoracic battle injuries in the Lebanon War: review of the early operative approach in 1,992 patients. Ann Thorac Surg. 1985 Sep;40(3):209-13 https://doi.org/10.1016/S0003-4975(10)60029-X
  2. Cushing BM, Clark DE, Cobean R, Schenarts PJ, Rutstein LA. Blunt and penetrating trauma - Has anything changed? Surg Clin of North Am. 1997;77(6):1321-32 https://doi.org/10.1016/S0039-6109(05)70620-4
  3. Bowley DM, Boffard KD. Penetrating trauma of the trunk. Unfallchirurg. 2001 Nov; 104(11):1032-42 https://doi.org/10.1007/s001130170017
  4. Mandal AK, Sanusi M. Penetrating chest wounds: 24 years experience. World J Surg. 2001 Sep;25(9):1145-9 https://doi.org/10.1007/BF03215862
  5. Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am. 1983 Aug; 249(2):28-35 https://doi.org/10.1038/scientificamerican0883-28
  6. Fingerhut LA. Firearm mortality among children, youth, and young adults 1-34 years of age, trends and current status: United States, 1985-90. Adv Data. 1993 Mar 23;(231): 1-20.)
  7. Borja AR, Ransdell HT. Treatment of penetrating gunshot wounds of the chest. Experience with one hundred forty-five cases. Am J Surg. 1971 Jul;122(1):81-4 https://doi.org/10.1016/0002-9610(71)90354-0
  8. Sandrasagra FA. Penetrating thoracoabdominal injuries. Br J Surg. 1977 Sep;64(9):638-40 https://doi.org/10.1002/bjs.1800640909
  9. Mattox KL, Wall MJ, Pickard LR: Thoracic trauma: General considerations and indications for thoracotomy. In Feliciano DV, Moore EE, Mattox KL (eds): Trauma, 3rd ed. Norwalk, CT, Appleton Lange, 1996:345-53
  10. Murray JA, Berne J, Asensio JA. Penetrating thoracoabdominal trauma. Emerg Med Clin North Am. 1998 Feb;16(1):107-28 https://doi.org/10.1016/S0733-8627(05)70351-5
  11. Marx JA. Penetrating abdominal trauma. Emerg Med Clin North Am. 1993 Feb;11(1): 125-35
  12. McCarthy MC, Lowdermilk GA, Canal DF, Broadie TA. Prediction of injury caused by penetrating wounds to the abdomen, flank, and back. Arch Surg. 1991 Aug;126(8):962- 5;discussion 965-6 https://doi.org/10.1001/archsurg.1991.01410320044004
  13. Rosemurgy AS 2nd, Albrink MH, Olson SM, Sherman H, Albertini J, Kramer R, Camps M, Reiss A. Abdominal stab wound protocol: prospective study documents applicability for widespread use. Am Surg. 1995 Feb;61(2): 112-6
  14. Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg. 1987 Feb;205(2):129-32 https://doi.org/10.1097/00000658-198702000-00005
  15. Shorr RM, Gottlieb MM, Webb K, Ishiguro L, Berne TV. Selective management of abdominal stab wounds. Importance of the physical examination. Arch Surg. 1988 Sep;123(9): 1141-5 https://doi.org/10.1001/archsurg.1988.01400330121018
  16. Asensio JA, Stewart BM, Murray J, Fox AH, Falabella A, Gomez H, Ortega A, Fuller CB, Kerstein MD. Penetrating cardiac injuries. Surg Clin North Am. 1996 Aug; 76(4):685-24