Impact of Aggressive Treatments in Trauma: Using the Emergent Department Thoracotomy to Death Ratio

The emergency department thoracotomy remains controversial. We sought to explore the correlation between trauma center practices with regard to emergency department thoracotomy performance and survival of patients admitted to these centers. We hypothesized that centers that perform emergency department thoracotomies liberally would not necessarily have increased survival. Level I and II trauma centers contributing data to the National Trauma Data Bank between 2007 and 2011 were included. The data were aggregated and the counts for emergency department thoracotomies and emergency department deaths were calculated for each center. Centers were then divided into quartiles based on the emergency department thoracotomies:emergency department deaths ratio. A multivariate logistic regression model was utilized to calculate the adjusted odds ratio for mortality. The primary outcome was overall mortality. A total of 174 trauma centers admitting 1,432,811 subjects were included. The median EDT:EDD ratio ranged from 0 for Q1 to 17.6% for centers in the highest quartile (Q4). Q4 centers were more likely to be level I (Q4: 67.4% vs. Q1: 44.2%, p = 0.03) and an academic center (Q4: 67.4% vs. Q1: 41.9%, p = 0.05). Compared to patients admitted to Q1 centers, those admitted to Q4 centers had a higher adjusted mortality (adjusted odds ratio: 1.1, 95% CI 1.02-1.10, adjusted p < 0.01). Trauma centers where emergency department thoracotomies are liberally performed had a higher adjusted mortality. Further investigation is required to identify areas for improvement and standardization of the management of the trauma patient in extremis.