Penetrating Chest Trauma Guidelines

Updated: Nov 20, 2019
  • Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Jeffrey C Milliken, MD  more...
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Guidelines

EAST Guideline on Traumatic Diaphragmatic Injuries

In 2018, the Eastern Association for the Surgery of Trauma (EAST) published guidelines on evaluation and management of traumatic diaphragmatic injuries. [31] Recommendations included the following:

  • In left thoracoabdominal stab wound patients who are hemodynamically stable and without peritonitis,  laparoscopy is conditionally recommended rather that computed tomography (CT) to decrease the incidence of missed diaphragmatic injury.
  • In penetrating thoracoabdominal trauma patients in whom a right diaphragm injury is confirmed or suspected and who are hemodynamically stable without peritonitis, nonoperative management is conditionally recommended over operative management in weighing the risks of delayed herniation, missed thoracoabdominal organ injury, and surgical morbidity (procedural complications, length of stay [LOS], surgical-site infection [SSI], empyema).
  • In hemodynamically stable trauma patients with acute diaphragm injuries, the abdominal approach, rather than the thoracic approach, is conditionally recommended for repairing the diaphragm to decrease mortality, delayed herniation, missed thoracoabdominal organ injury, and surgical approach–associated morbidity (procedural complications, LOS, SSI, empyema).
  • In patients who present with delayed visceral herniation through a traumatic diaphragmatic injury, no recommendation is made in regard to the routine surgical approach (abdominal or thoracic) to decrease mortality and surgical approach–related morbidity (procedural complications, SSI, LOS, empyema).
  • In patients with acute penetrating diaphragmatic injuries without concern for other intra-abdominal injuries,  laparoscopic repair is conditionally recommended over open repair in weighing the risks of mortality, delayed herniation, missed thoracoabdominal organ injury, and surgical approach–associated morbidity (procedural complications, LOS, SSI, empyema).
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EAST Guidelines for Emergency Department Thoracotomy

In 2015, EAST published guidelines for emergency department (ED) thoracotomy (EDT) in common presenting scenarios after critical injury. [9] Recommendations included the following:

  • In patients presenting pulseless to the ED with signs of life after penetrating thoracic injury, EDT is strongly recommended.
  • In patients presenting pulseless to the ED without signs of life after penetrating thoracic injury, EDT is conditionally recommended.
  • In patients presenting pulseless to the ED with signs of life after penetrating extrathoracic injury, EDT is conditionally recommended. This recommendation does not pertain to patients with isolated cranial injuries.
  • In patients presenting pulseless to the ED without signs of life after penetrating extrathoracic injury, EDT is conditionally recommended. This recommendation does not pertain to patients with isolated cranial injuries.
  • In patients presenting pulseless to the ED with signs of life after blunt injury, EDT is conditionally recommended.
  • In patients presenting pulseless to the ED without signs of life after blunt injury, it is conditionally recommended that EDT not be performed.
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