Dangerous passage: the utility and accuracy of modern chest computed tomography in penetrating thoracic injuries with potential transmediastinal trajectory.
Chest trauma
Computed tomography
Penetrating trauma
Transmediastinal gunshot wounds
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
26 Jun 2023
26 Jun 2023
Historique:
received:
05
02
2023
accepted:
20
06
2023
medline:
26
6
2023
pubmed:
26
6
2023
entrez:
26
6
2023
Statut:
aheadofprint
Résumé
The aim of this study is to evaluate utility and reliability of chest CT as a standalone screening modality for stable patients with thoracic GSWs and potential transmediastinal trajectories. All patients with thoracic GSWs over a 5-year period were identified. Unstable patients requiring immediate surgery were excluded and the remaining underwent chest CT with intravenous contrast. Sensitivity and specificity for clinically significant injuries were tested against an aggregate gold standard of discharge diagnosis including imaging, operative and clinical findings. A total of 216 patients met inclusion criteria and underwent chest CT. After imaging, 65 (30.1%) had indication for immediate surgery, of which 10 (4.6%) underwent a thoracic procedure for chest injuries while 151 (69.9%) were selected for nonoperative management (NOM). 11 (5.1%) required a delayed thoracic operation, none due to injuries missed on CT. The remaining 140 (64.8%) underwent successful NOM. Up to 195 (90.3%) patients had successful NOM of thoracic injuries. Only 9.2% required additional imaging, all negative. CT identified a cardiac injury in one case and a vascular injury in two cases, all confirmed by surgery, while one thoracic IVC injury missed on CT was found intraoperatively. 2 patients had CT suspicious for esophageal injury, ruled out by following investigations. There was one death in the total cohort, none in the NOM group. Modern high-quality CT provides highly accurate and reliable screening modality for penetrating chest and mediastinal injuries and can be used as a standalone study in most patients or to guide further tests. Chest CT facilitated successful NOM.
Identifiants
pubmed: 37358631
doi: 10.1007/s00068-023-02315-8
pii: 10.1007/s00068-023-02315-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
Degiannis E, Benn CA, Leandros E, Goosen J, Boffard K, Saadia R. Transmediastinal gunshot injuries. Surgery. 2000;128(1):54–8. https://doi.org/10.1067/msy.2000.106463 .
doi: 10.1067/msy.2000.106463
pubmed: 10876186
Cornwell EE 3rd, Kennedy F, Ayad IA, Berne TV, Velmahos G, Asensio J, Demetriades D. Transmediastinal gunshot wounds. A reconsideration of the role of aortography. Arch Surg. 1996;131(9):949–52. https://doi.org/10.1001/archsurg.1996.01430210047009 . (discussion 952-3).
doi: 10.1001/archsurg.1996.01430210047009
pubmed: 8790180
Renz BM, Cava RA, Feliciano DV, Rozycki GS. Transmediastinal gunshot wounds: a prospective study. J Trauma. 2000;48(3):416–21. https://doi.org/10.1097/00005373-200003000-00008 .
doi: 10.1097/00005373-200003000-00008
pubmed: 10744278
Burack JH, Kandil E, Sawas A, O’Neill PA, Sclafani SJ, Lowery RC, Zenilman ME. Triage and outcome of patients with mediastinal penetrating trauma. Ann Thorac Surg. 2007;83(2):377–82. https://doi.org/10.1016/j.athoracsur.2006.05.107 . (discussion 382).
doi: 10.1016/j.athoracsur.2006.05.107
pubmed: 17257952
Okoye OT, Talving P, Teixeira PG, Chervonski M, Smith JA, Inaba K, Noguchi TT, Demetriades D. Transmediastinal gunshot wounds in a mature trauma centre: changing perspectives. Injury. 2013;44(9):1198–203. https://doi.org/10.1016/j.injury.2012.12.014 .
doi: 10.1016/j.injury.2012.12.014
pubmed: 23298755
Demetrios D, Velmahos GC. Penetrating injuries of the chest: indication for operation. Scand J Surg. 2002;91(1):41–5. https://doi.org/10.1177/145749690209100107 .
doi: 10.1177/145749690209100107
Nagy KK, Roberts RR, Smith RF, Joseph KT, An GC, Bokhari F, Barrett J. Trans-mediastinal gunshot wounds: are “stable” patients really stable? World J Surg. 2002;26(10):1247–50. https://doi.org/10.1007/s00268-002-6522-2 .
doi: 10.1007/s00268-002-6522-2
pubmed: 12209227
Grossman MD, May AK, Schwab CW, Reilly PM, McMahon DJ, Rotondo M, Shapiro MB, Kauder DR, Frankel H, Anderson H 3rd. Determining anatomic injury with computed tomography in selected torso gunshot wounds. J Trauma. 1998;45(3):446–56. https://doi.org/10.1097/00005373-199809000-00004 .
doi: 10.1097/00005373-199809000-00004
pubmed: 9751533
Ibirogba S, Nicol AJ, Navsaria PH. Screening helical computed tomographic scanning in haemodynamic stable patients with transmediastinal gunshot wounds. Injury. 2007;38(1):48–52. https://doi.org/10.1016/j.injury.2006.07.039 .
doi: 10.1016/j.injury.2006.07.039
pubmed: 17054956
Stassen NA, Lukan JK, Spain DA, Miller FB, Carrillo EH, Richardson JD, Battistella FD. Reevaluation of diagnostic procedures for transmediastinal gunshot wounds. J Trauma. 2002;53(4):635–8. https://doi.org/10.1097/00005373-200210000-00003 . (discussion 638).
doi: 10.1097/00005373-200210000-00003
pubmed: 12394859
Hanpeter DE, Demetriades D, Asensio JA, Berne TV, Velmahos G, Murray J. Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds. J Trauma. 2000;49(4):689–94. https://doi.org/10.1097/00005373-200010000-00017 . (discussion 694-5).
doi: 10.1097/00005373-200010000-00017
pubmed: 11038087