Review of chest injuries in a trauma centre without local cardiothoracic surgery.

BACKGROUND AND AIMS: The vast majority of UK Major Trauma Centres either have on site cardiothoracic surgery or are located in proximity to a cardiothoracic centre. One exception is Ninewells Hospital, Dundee, which is located 70 miles from the nearest cardiothoracic department. The nature of this atypical arrangement and its implications are reviewed.

METHODS AND

RESULTS

The Scottish Trauma Audit group (STAG) was searched for details of patients sustaining a thoracic injury and presenting to NHS Tayside over a 17 month period. Data were analyzed for demographic information, mechanisms of injury, associated injuries, management and outcome. 250 trauma patients were identified. One hundred and twelve patients (44.8%) were aged seventy years or older. Two hundred and thirteen patients (85.2%) underwent a thoracic CT scan. Fifty three patients (21%) required regional anaesthesia and 29 (12%) needed a chest drain. One patient underwent a resuscitative thoracotomy and 2 needed subclavian artery embolisation. Only 1 patient required an emergency transfer to a cardiothoracic centre.

CONCLUSION

A trauma centre without local cardio-thoracic surgery can deal with the majority of chest injuries. The contemporary management of chest injuries includes the liberal usage of CT scanning and regional anaesthetic techniques. The need for surgical intervention or transfer to a cardio-thoracic facility is rare.