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Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre
  1. Astree Swiech1,
  2. G Boddaert2,
  3. J-L Daban1,
  4. E Falzone1,
  5. S Ausset1 and
  6. M Boutonnet1
  1. 1Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart, France
  2. 2Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
  1. Correspondence to Dr Astree Swiech, Anesthesiology and Intensive Care Medicine, Percy Military Teaching Hospital, Clamart 92190, France; astree.swiech{at}gmail.com

Abstract

Background Penetrating thoracic injuries (PTIs) is a medicosurgical challenge for civilian and military trauma teams. In civilian European practice, PTIs are most likely due to stab wounds and mostly require a simple chest tube drainage. On the battlefield, combat casualties suffer severe injuries, caused by high-lethality wounding agents.

The aim of this study was to analyse and compare the demographics, injury patterns, surgical management and clinical outcomes of civilian and military patients with PTIs.

Methods All patients with PTIs admitted to a Level I Trauma Centre in France or to Role-2 facilities in war theatres between 1 January 2004 and 31 May 2016 were included. Combat casualties’ data were analysed from Role-2 medical charts. The hospital manages military casualties evacuated from war theatres who had already received primary surgical care, but also civilian patients issued from the Paris area. During the study period, French soldiers were deployed in Afghanistan, in West Africa and in the Sahelo-Saharan band since 2013.

Results 52 civilian and 17 military patients were included. Main mechanisms of injury were stab wounds for civilian patients, and gunshot wounds and explosive fragments for military casualties. Military patients suffered more severe injuries and needed more thoracotomies. In total, 29 (33%) patients were unstable or in cardiac arrest on admission. Thoracic surgery was performed in 38 (55%) patients (25 thoracotomies and 13 thoracoscopies). Intrahospital mortality was 18.8%.

Conclusion War PTIs are associated with extrathoracic injuries and higher mortality than PTIs in the French civilian area. In order to reduce the mortality of PTIs in combat, our study highlights the need to improve tactical en route care with transfusion capabilities and the deployment of forward surgical units closer to the combatants. In the civilian area, our results indicated that video-assisted thoracoscopic surgery is a reliable diagnostic and therapeutic technique for haemodynamically stable patients.

  • penetrating thoracic injury
  • military medicine
  • thoracotomy
  • video-assisted thoracoscopic surgery (vats)
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Footnotes

  • Contributors All authors contributed to this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the French Ethic Committee for Research in Anesthesia and Intensive Care (CERAR).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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