Branney S W, Moore E E, Feldhaus K M, Wolfe R E
Denver Health Medical Center, Colorado 80204, USA.
J Trauma. 1998 Jul;45(1):87-94; discussion 94-5. doi: 10.1097/00005373-199807000-00019.
Despite numerous studies, no clear consensus exists for the optimal use of emergency department thoracotomy (EDT). As such, we have continued to critically review our experience with EDT during the last 23 years to clarify indications for EDT and evaluate its cost-effectiveness.
This was a retrospective review of 950 EDTs performed at our regional Level I trauma center during the last 23 years. Cost-benefit ratios were calculated using standardized models.
In 23 years, 950 patients underwent postinjury thoracotomy. We were able to obtain the complete medical records for 868 patients (91%). Overall survival was 4.4%, with 3.9% surviving functionally intact. All survivors of blunt trauma had either palpable pulse or recorded blood pressure in the field. Blunt trauma functional survival when field vital signs were present was 2.5%. Of note, 26.5% of our functional survivors sustained penetrating injuries and had no pulse or blood pressure in the field. Stab wounds to the chest and gunshot wounds to the abdomen were the two mechanisms of injury most likely to be survived. The benefit-charge ratio was strongly in favor of performing EDT at 5.6:1; it was 1.8:1 if adjusted for the cost of maintaining all neurologically injured survivors throughout their lifetime.
EDT is efficacious and cost-effective for select patient populations. We suggest a key clinical pathway for the use of EDT that would reduce the number of procedures by at least 32% without changing the number of neurologically intact survivors.
尽管进行了大量研究，但对于急诊开胸手术（EDT）的最佳应用尚无明确共识。因此，我们在过去23年中持续严格回顾我们的EDT经验，以明确EDT的适应证并评估其成本效益。
这是一项对我们地区一级创伤中心在过去23年中进行的950例EDT的回顾性研究。使用标准化模型计算成本效益比。
在23年中，950例患者接受了伤后开胸手术。我们能够获取868例患者（91%）的完整病历。总体生存率为4.4%，功能完好存活者为3.9%。所有钝性创伤幸存者在现场均可触及脉搏或记录到血压。现场有生命体征时钝性创伤功能存活者为2.5%。值得注意的是，我们26.5%的功能存活者为穿透性损伤，在现场无脉搏或血压。胸部刺伤和腹部枪伤是最有可能存活的两种损伤机制。效益费用比强烈支持进行EDT，为5.6:1；如果调整为维持所有神经损伤幸存者终身的费用，则为1.8:1。
EDT对特定患者群体有效且具有成本效益。我们建议采用一条关键的EDT临床路径，该路径可在不改变神经功能完好存活者数量的情况下，将手术数量至少减少32%。
