COMMON INJURY PATTERNS IN TRAUMA PATIENTS ARRIVING IN EXTREMIS

Objectives: With improvement in prehospital care, more trauma patients present to trauma centers in extremis. Resuscitative thoracotomy (RT) may be utilized to obtain a perfusing rhythm, but identifying and treating bleeding immediately after successful RT is mandatory for survival. Trauma surgeons must be able to manage all injuries in these cases as there will likely not be enough time to obtain specialty consultation or to use endovascular management. We sought to determine common sources of bleeding in patients arriving in extremis and the injuries that require operative management.

Methods: A retrospective review was conducted of all patients who underwent RT at a high-volume Level 1 trauma center from 2010 to 2020. Those who had an autopsy report or lived to discharge were included in the study. Patients who had a thoracotomy outside of the trauma resuscitation unit were excluded. Data collection included patient demographics, mechanism of injury, and injury characteristics. Additional grading information was gathered on injury patterns that often require operative management by trauma surgeons.

Results: There were 179 patients meeting inclusion criteria, of which 109 (60.9%) presented after penetrating trauma and 70 (39.1%) after blunt trauma. The mean age was 34.9 years and 86.0% were male. Common injuries encountered in the penetrating cohort included: lung (54.1%), cardiac (40.4%), and hepatic injuries (29.4%). Just under half of blunt patients (44.3%) had traumatic brain injury, 35.7% had pelvic fractures, and 34.3% hepatic injuries. The mean grade of cardiac injuries among penetrating patients was 4.2  0.6, while the mean hepatic grade was 3.7  0.8 and 3.7  1.1 among penetrating and blunt patients, respectively.

Conclusion: High grade cardiac and liver are commonly seen when trauma patients arrive in extremis. Trauma surgeons must be able to manage such injuries as obtaining specialty consultation and/or using endovascular therapy is not feasible.