PMID- 37544864 OWN - NLM STAT- MEDLINE DCOM- 20231225 LR - 20240102 IS - 1879-0267 (Electronic) IS - 0020-1383 (Linking) VI - 55 IP - 1 DP - 2024 Jan TI - Outcomes and potential for improvement in the prehospital treatment of penetrating chest injuries in a European metropolitan area: A retrospective analysis of 2009 - 2017. PG - 110971 LID - S0020-1383(23)00657-5 [pii] LID - 10.1016/j.injury.2023.110971 [doi] AB - BACKGROUND: Trauma is the leading cause of death in patients <45 years living in high-resource settings. However, penetrating chest injuries are still relatively rare in Europe - with an upwards trend. These cases are of particular interest to emergency medical services (EMS) due to available invasive treatment options like chest tube placement or resuscitative thoracotomy. To date, there is no sufficient data from Austria regarding penetrating chest trauma in a metropolitan area, and no reliable source to base decisions regarding further skill proficiency training on. METHODS: For this retrospective observational study, we screened all trauma emergency responses of the Viennese EMS between 01/2009 and 12/2017 and included all those with a National Advisory Committee for Aeronautics (NACA) score >/= IV (= potentially life-threatening). Data were derived from EMS mission documentations and hospital files, and for those cases with the injuries leading to cardiopulmonary resuscitation (CPR), we assessed the EMS cardiac arrest registry and consulted a forensic physician. RESULTS: We included 480 cases of penetrating chest injuries of NACA IV-VII (83% male, 64% > 30 years old, 74% stab wounds, 16% cuts, 8% gunshot wounds, 56% inflicted by another party, 26% self-inflicted, 18% unknown). In the study period, the incidence rose from 1.4/100,000 to 3.5/100,000 capita, and overall, about one case was treated per week. In the cases with especially severe injury patterns (= NACA V-VII, 43% of total), (tension-)pneumothorax was the most common injury (29%). The highest mortality was seen in injuries to pulmonary vessels (100%) or the heart (94%). Fifty-eight patients (12% of total) deceased, whereas in 15 cases, the forensic physician stated survival could theoretically have been possible. However, only five of these CPR patients received at least unilateral thoracostomy. Regarding all penetrating chest injuries, thoracostomy had only been performed in eight patients. CONCLUSIONS: Severe cases of penetrating chest trauma are rare in Vienna and happened about once a week between 2009 and 2017. Both incidence and case load increased over the years, and potentially life-saving invasive procedures were only reluctantly applied. Therefore, a structured educational and skill retention approach aimed at both paramedics and emergency physicians should be implemented. TRIAL REGISTRATION: Retrospective analysis without intervention. CI - Copyright (c) 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved. FAU - Krammel, Mario AU - Krammel M AD - Emergency Medical Service Vienna, Vienna, Austria. FAU - Frimmel, Nikolaus AU - Frimmel N AD - Dept. of Anaesthesia, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, Vienna, Austria. FAU - Hamp, Thomas AU - Hamp T AD - Emergency Medical Service Vienna, Vienna, Austria; Dept. of Anaesthesia, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, Vienna, Austria. FAU - Grassmann, Daniel AU - Grassmann D AD - Emergency Medical Service Vienna, Vienna, Austria. FAU - Widhalm, Harald AU - Widhalm H AD - Dept. of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria. FAU - Verdonck, Philip AU - Verdonck P AD - Dept. of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium. FAU - Reisinger, Christoph AU - Reisinger C AD - Center for Forensic Medicine, Medical University of Vienna, Vienna, Austria. FAU - Sulzgruber, Patrick AU - Sulzgruber P AD - Division of Cardiology, Dept. of Internal Medicine II, Medical University of Vienna, Vienna, Austria. FAU - Schnaubelt, Sebastian AU - Schnaubelt S AD - Dept. of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium; Dept. of Emergency Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: sebastian.schnaubelt@meduniwien.ac.at. LA - eng PT - Journal Article PT - Observational Study DEP - 20230804 PL - Netherlands TA - Injury JT - Injury JID - 0226040 SB - IM MH - Humans MH - Male MH - Adult MH - Female MH - Retrospective Studies MH - *Wounds, Gunshot/complications MH - *Thoracic Injuries/epidemiology/therapy/complications MH - *Wounds, Penetrating/epidemiology/therapy/complications MH - *Emergency Medical Services/methods MH - *Pneumothorax/etiology OTO - NOTNLM OT - Emergency medical service OT - Emergency medicine OT - Penetrating chest injury OT - Pre-hospital care OT - Trauma OT - Trauma surgery COIS- Declaration of Competing Interest We declare: Mario Krammel is medical director of the Viennese EMS. Sebastian Schnaubelt is Vice-Chair of the Austrian Resuscitation Council. Both do not see these affiliations as conflicting with the content of the manuscript at hand. The other authors declare no COI relevant to this study. EDAT- 2023/08/07 00:42 MHDA- 2023/12/25 06:43 CRDT- 2023/08/06 21:56 PHST- 2023/03/15 00:00 [received] PHST- 2023/07/08 00:00 [revised] PHST- 2023/08/01 00:00 [accepted] PHST- 2023/12/25 06:43 [medline] PHST- 2023/08/07 00:42 [pubmed] PHST- 2023/08/06 21:56 [entrez] AID - S0020-1383(23)00657-5 [pii] AID - 10.1016/j.injury.2023.110971 [doi] PST - ppublish SO - Injury. 2024 Jan;55(1):110971. doi: 10.1016/j.injury.2023.110971. Epub 2023 Aug 4.