Surgical management of major thoracic injuries.

Major thoracic injuries are uncommon in the United Kingdom and wide experience of their management by centres in this country has not been reported. Between 1985 and 1990, 23 patients have undergone urgent thoracotomy at Birmingham Accident Hospital for suspected intrathoracic injury. The majority of these injuries were caused by penetrating trauma (13 patients). The commonest indications for thoracotomy were suspected intrathoracic haemorrhage in 13 patients and suspected cardiac tamponade in four patients. In three of the four patients with suspected cardiac tamponade, the diagnosis was correct, the tamponade successfully relieved together with repair of the lesion, and all three patients survived. Of the 13 patients with intrathoracic haemorrhage, 10 survived after control of haemorrhage and repair of the lesion but three died: one from uncontrollable haemorrhage from a right middle lobe vessel laceration, one from associated multiple injuries and one from post-operative complications. The TRISS methodology was applied to audit our results. Two patients who died after a penetrating injury had a greater than 50 per cent probability of death by the TRISS method. Two patients who died after a blunt injury had a less than 50 per cent probability of death by the TRISS method although one of these patients died from postoperative complications. This series illustrates the point that prompt recognition of a suspected intrathoracic injury and appropriate urgent surgical intervention to relieve cardiac tamponade and control intrathoracic haemorrhage in these patients can produce a successful outcome. In addition it it is essential that all units audit their own results in order to highlight areas where improvements in trauma care can be made.