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Life after near death: Long-term outcomes of emergency department thoracotomy survivors

Keller, Deborah MS, MD; Kulp, Heather RN, MSN; Maher, Zoe MD; Santora, Thomas A. MD; Goldberg, Amy J. MD; Seamon, Mark J. MD

Journal of Trauma and Acute Care Surgery: May 2013 - Volume 74 - Issue 5 - p 1315–1320
doi: 10.1097/TA.0b013e31828c3db4
Original Articles

BACKGROUND: Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, functional, and psychological outcomes in EDT survivors.

METHODS: Review of our Level I trauma center registry (2000–2010) revealed that 37 of 448 patients survived hospitalization after EDT. Demographics and clinical characteristics were analyzed. After attempts to contact survivors, 21 patients or caretakers were invited to an outpatient study evaluation; 16 were unreachable (none of whom were present in the Social Security Death Index). Study evaluation included demographic and social data and an outpatient multidisciplinary assessment with validated scoring instruments (Mini-Mental Status Exam, Glasgow Outcome Scores, Timed Get-Up and Go Test, Functional Independence Measure Scoring, SF-36 Health Survey, and civilian posttraumatic stress disorder checklist).

RESULTS: After extended hospitalization (43 ± 41 days), disposition varied (home, 62%; rehabilitation, 32%; skilled nursing facility, 6%), but readmission was common (33%) in the 37 EDT hospital survivors. Of the 21 contacted, 16 completed the study evaluation, 2 had died, 1 remained in a comatose state, and 2 were available by telephone only. While unemployment (75%), daily alcohol (50%), and drug use (38%) were common, of the 16 patients who underwent the comprehensive, multidisciplinary outpatient assessment after a median of 59 months following EDT, 75% had normal cognition and returned to normal activities, 81% were freely mobile and functional, and 75% had no evidence of posttraumatic stress disorder upon outpatient screening.

CONCLUSION: Despite the common belief that EDT survivors often live with severe neurologic or functional impairment, we have found that most of our sampled EDT survivors had no evidence of long-term impairment. It is our hope that these results are considered by physicians making life or death decisions regarding the “futility” of EDT in our most severely injured patients.

LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.

From the Department of Surgery (D.K.), University Hospital-Case Medical Center, Cleveland, Ohio; Alfred I. duPont Children’s Hospital (H.K.), Wilmington, Delaware; Division of Trauma and Surgical Critical Care (T.A.S., A.J.G.), Department of Surgery (Z.M.), Temple University School of Medicine, Philadelphia, Pennsylvania; and Division of Trauma and Surgical Critical Care (M.J.S.), Department of Surgery, Cooper University Hospital, Camden, New Jersey.

Submitted: July 16, 2012, Revised: December 20, 2012, Accepted: December 20, 2012.

This study was presented as a poster at the 70th annual meeting of the American Association for the Surgery of Trauma, September 14–17, 2011, in Chicago, Illinois.

Address for reprints: Mark J. Seamon, MD, Division of Trauma and Surgical Critical Care, Department of Surgery, Cooper University Hospital 3 Cooper Plaza, Suite #411, Camden, NJ 08103; email: seamon-mark@CooperHealth.edu.

© 2013 Lippincott Williams & Wilkins, Inc.