ORIGINAL ARTICLESEmergency department at the cutting edgeFerris, John D.; Smith, Innes; Robertson, Colin E.Author Information Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK Correspondence to Dr John D. Ferris, MBChB, BSc, Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK Tel: +44 7766117330; e-mail: [email protected] Received 28 November 2006 Accepted 24 January 2007 European Journal of Emergency Medicine: April 2008 - Volume 15 - Issue 2 - p 67-70 doi: 10.1097/MEJ.0b013e328125fef5 Buy Metrics Abstract Objective This paper reviews the experience of penetrating chest trauma over a 3-year period in one UK emergency department. Methods A retrospective review was performed of patients assessed in the emergency department resuscitation room between 1 January 2002 and 31 December 2005. Patients with penetrating chest trauma, either isolated or in combination with other injuries, were included. A Medline search was performed using the terms ‘chest’, ‘trauma’ and ‘penetrating’. Results A total of 120 patients presented with penetrating chest trauma. Ninety-two percent were male. Ninety-six percent (115) of the patients survived to hospital discharge. Seventy-eight percent of the patients presented at night (20.00 and 8.00 h). A single wound accounted for 52% (63) of patients, multiple wounds 43% (52) with 2% (two) gun-shot wounds and 3% (three) impalings. The mean prehospital time of patients in cardiac arrest was 42 min with a mean on-scene time of 24 min. The mean prehospital time for patients undergoing formal emergency surgery was 39 min with a mean on-scene time of 16 min. Twenty-three patients required one or more tube thoracostomies to be performed in the emergency department and six underwent emergency department thoracotomy. Sixteen patients required immediate formal emergency surgery for haemorrhage control. Conclusion Penetrating chest trauma contributes significantly to our trauma workload with a high proportion of patients sustaining life-threatening injuries requiring immediate intervention. Significant prehospital delays occur. Overall mortality of 4.2% is comparable with that of a major American case series. Further education and protocol development is required to ensure that prehospital and emergency department management of these patients reflects the latest evidence-based guidelines. © 2008 Lippincott Williams & Wilkins, Inc.