{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:38:21Z","timestamp":1790710701057,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T00:00:00Z","timestamp":1630022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: Current guidelines on urgent thoracotomy of polytraumatized patients are based on data from perforating chest injuries. We aimed to identify predictive factors for urgent thoracotomy after chest-tube placement for blunt chest trauma in a civilian setting. Methods: Polytraumatized patients (Injury Severity Score \u226516) with blunt chest trauma, submitted to a level I trauma centre during a period of 12 years that received at least one chest tube were included. Trauma mechanism, chest-tube output, haemoglobin values, need for cellular blood products, coagulopathies, rib fracture pattern, thoracotomy, and mortality were retrospectively analysed. Results: 235 polytraumatized patients were included. Patients that received urgent thoracotomy (UT, n = 10) showed a higher mean chest-tube output within 24 h with a median (Mdn) of 3865 (IQR 2423\u20135156) mL compared to the group with no additional thoracic surgery (NT, n = 225) with Mdn 185 (IQR 50\u2013463) mL (p &lt; 0.001). The cut-off 24-h chest-tube output value for recommended thoracotomy was 1270 mL (ROC-Curve). UT showed an initial haemoglobin of Mdn 11.7 (IQR 9.2\u201314.3) g\/dL and an INR value of Mdn 1.27 (IQR 1.11\u20131.69) as opposed to Mdn 12.3 (IQR 10\u201313.9) g\/dL and Mdn 1.13 (IQR 1.05\u20131.34) in NT (haemoglobin: p = 0.786; INR: p = 0.215). There was an average number of 7.1(\u00b13.4) rib fractures in UT and 6.7(\u00b14.8) in NT (p = 0.649). Conclusions: Chest-tube output remains the single most important predictive factor for urgent thoracotomy also after blunt chest trauma. Patients with a chest-tube output of more than 1300 mL within 24 h after trauma should be considered for transfer to a level I trauma centre with standby thoracic surgery.<\/jats:p>","DOI":"10.3390\/jcm10173843","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T11:01:37Z","timestamp":1630321297000},"page":"3843","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Blunt Chest Trauma in Polytraumatized Patients: Predictive Factors for Urgent Thoracotomy"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2490-1749","authenticated-orcid":false,"given":"Josef","family":"Stolberg-Stolberg","sequence":"first","affiliation":[{"name":"Department of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Christoph","family":"Katthagen","sequence":"additional","affiliation":[{"name":"Department of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Hillemeyer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care, and Pain Medicine, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building A1, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten","family":"Wiebe","sequence":"additional","affiliation":[{"name":"Section of Thoracic Surgery and Lung Transplantation, Department of Cardiothoracic Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building A1, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3640-2995","authenticated-orcid":false,"given":"Jeanette","family":"Koeppe","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Raschke","sequence":"additional","affiliation":[{"name":"Department of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.medin.2014.06.012","article-title":"Epidemiology of severe trauma","volume":"38","author":"Alberdi","year":"2014","journal-title":"Med. Intensiv."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Pfeifer, R., Teuben, M., Andruszkow, H., Barkatali, B.M., and Pape, H.C. (2016). Mortality Patterns in Patients with Multiple Trauma: A Systematic Review of Autopsy Studies. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148844"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/01.ta.0000251558.38388.47","article-title":"Preventable deaths from hemorrhage at a level I Canadian trauma center","volume":"62","author":"Tien","year":"2007","journal-title":"J. Trauma"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S172","DOI":"10.21037\/jtd.2017.03.52","article-title":"Management of chest trauma","volume":"9","author":"Ludwig","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1093\/icvts\/ivu397","article-title":"Surgical management for the first 48 h following blunt chest trauma: State of the art (excluding vascular injuries)","volume":"20","author":"Avaro","year":"2015","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.ejcts.2004.04.011","article-title":"Management of 150 flail chest injuries: Analysis of risk factors affecting outcome","volume":"26","author":"Athanassiadi","year":"2004","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s13049-014-0052-4","article-title":"Predictors of poor outcomes after significant chest trauma in multiply injured patients: A retrospective analysis from the German Trauma Registry (Trauma Register DGU(R))","volume":"22","author":"Huber","year":"2014","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.jss.2011.09.018","article-title":"Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma","volume":"176","author":"Mommsen","year":"2012","journal-title":"J. Surg. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.suc.2006.09.014","article-title":"Thoracic trauma: When and how to intervene","volume":"87","author":"Meredith","year":"2007","journal-title":"Surg. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/S1072-7515(99)00233-1","article-title":"Survival after emergency department thoracotomy: Review of published data from the past 25 years","volume":"190","author":"Rhee","year":"2000","journal-title":"J. Am. Coll. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e000201","DOI":"10.1136\/tsaco-2018-000201","article-title":"Improving survival after an emergency resuscitative thoracotomy: A 5-year review of the Trauma Quality Improvement Program","volume":"3","author":"Joseph","year":"2018","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s00113-011-2103-x","article-title":"S3 guideline on treatment of polytrauma\/severe injuries. Trauma room care","volume":"115","author":"Lendemans","year":"2012","journal-title":"Unfallchirurg"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.accpm.2017.01.003","article-title":"Chest trauma: First 48hours management","volume":"36","author":"Bouzat","year":"2017","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_14","unstructured":"American College of Surgeons Committee on Trauma (2018). Advanced Trauma Life Support: Student Course Manual, American College of Surgeons."},{"key":"ref_15","unstructured":"Walls, R.M., Hockberger, R.S., Gausche-Hill, M., Bakes, K., Baren, J.M., Erickson, T.B., Jagoda, A.S., Kaji, A.H., VanRooyen, M., and Zane, R.D. (2018). Rosen\u2019s Emergency Medicine Concepts and Clinical Practice, Elsevier."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S1072-7515(02)01668-X","article-title":"Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: Joint position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma","volume":"196","author":"Hopson","year":"2003","journal-title":"J. Am. Coll. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/S1072-7515(01)00999-1","article-title":"Practice management guidelines for emergency department thoracotomy","volume":"193","author":"Asensio","year":"2001","journal-title":"J. Am. Coll. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/S0003-4975(10)65367-2","article-title":"Thoracic injuries in combat casualties in Vietnam","volume":"10","author":"McNamara","year":"1970","journal-title":"Ann. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/TA.0000000000000470","article-title":"Evaluation and management of blunt traumatic aortic injury: A practice management guideline from the Eastern Association for the Surgery of Trauma","volume":"78","author":"Fox","year":"2015","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1053\/j.semtcvs.2008.01.004","article-title":"Flail chest and pulmonary contusion","volume":"20","author":"Bastos","year":"2008","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_21","unstructured":"Abshagen, K.F., Stolberg-Stolberg, J., Loyen, J.P., Riesenbeck, O., Everding, J., Freise, H., and Raschke, M.J. (2021). Improvement in breathing mechanics by plate osteosynthesis of the ribs after cardiac massage: Case report and review of the literature. Unfallchirurg."},{"key":"ref_22","unstructured":"Unfallchirurgie (2016). S3-Leitlinie Polytrauma\/Schwerverletzten-Behandlung, Deutsche Gesellschaft f\u00fcr Unfallchirurgie. AWMF Register-Nr. 012\/019."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/SLA.0b013e318204a892","article-title":"Diagnostic accuracy and receiver-operating characteristics curve analysis in surgical research and decision making","volume":"253","author":"Soreide","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_24","first-page":"97","article-title":"Exigent postinjury thoracotomy analysis of blunt versus penetrating trauma","volume":"175","author":"Mansour","year":"1992","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1002\/ams2.148","article-title":"Thoracotomy for blunt chest trauma: Is chest tube output a useful criterion?","volume":"3","author":"Mizushima","year":"2016","journal-title":"Acute Med. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1001\/archsurg.136.5.513","article-title":"Timing of urgent thoracotomy for hemorrhage after trauma: A multicenter study","volume":"136","author":"Jurkovich","year":"2001","journal-title":"Arch. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S186","DOI":"10.21037\/jtd.2019.01.53","article-title":"Chest drain and thoracotomy for chest trauma","volume":"11","author":"Bertoglio","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1177\/000313480306901218","article-title":"Thoracotomy for blunt trauma: Traditional indications may not apply","volume":"69","author":"Hoth","year":"2003","journal-title":"Am. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1757-7241-16-15","article-title":"Pre-notification of arriving trauma patient at trauma centre: A retrospective analysis of the information in 700 consecutive cases","volume":"16","author":"Handolin","year":"2008","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.athoracsur.2013.04.033","article-title":"Utilization of cardiothoracic surgeons for operative penetrating thoracic trauma and its impact on clinical outcomes","volume":"96","author":"Mollberg","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e13079","DOI":"10.5812\/traumamon.13079","article-title":"Blunt Thoracic Injury Mortality and Clinical Presentation","volume":"23","author":"Yadollahi","year":"2018","journal-title":"Trauma Mon."},{"key":"ref_32","first-page":"102","article-title":"Early VATS for blunt chest trauma: A management technique underutilized by acute care surgeons","volume":"71","author":"Smith","year":"2011","journal-title":"J. Trauma"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e000064","DOI":"10.1136\/tsaco-2016-000064","article-title":"Comprehensive approach to the management of the patient with multiple rib fractures: A review and introduction of a bundled rib fracture management protocol","volume":"2","author":"Witt","year":"2017","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s00068-019-01119-z","article-title":"Mechanism of injury, injury patterns and associated injuries in patients operated for chest wall trauma","volume":"47","author":"Caragounis","year":"2021","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e201316","DOI":"10.1001\/jamanetworkopen.2020.1316","article-title":"Association Between Adherence to Evidence-Based Practices for Treatment of Patients With Traumatic Rib Fractures and Mortality Rates Among US Trauma Centers","volume":"3","author":"Tignanelli","year":"2020","journal-title":"JAMA Netw. Open"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/17\/3843\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:53:30Z","timestamp":1760165610000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/17\/3843"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,27]]},"references-count":35,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["jcm10173843"],"URL":"https:\/\/doi.org\/10.3390\/jcm10173843","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,27]]}}}