What percentage of patients with thoracic trauma require thoracotomy?

A. 10%–15%.

DISCUSSION: Twenty-five per cent of civilian trauma deaths are caused by thoracic trauma, and two thirds of these deaths occur after the patient reaches the hospital. Mortality of hospitalized patients with isolated chest injury ranges from 4% to 8% and increases to 35% when multiple additional organ systems are involved. Despite high mortality, only 10% to 15% of thoracic injuries require thoracotomy. Most injuries are successfully managed by the rather simple lifesaving maneuvers of airway control and tube thoracotomy. Unrelenting hemorrhage following either penetrating or blunt thoracic trauma is a primary indication for immediate thoracotomy. An initial thoracic blood loss of greater than 1500 ml. (30% of blood volume) or an ongoing loss of 250 ml. for 3 consecutive hours serves only as a practical guideline. The patient's hemodynamic status and overall condition should be the most influential factors.