Journal of the College of Physicians and Surgeons Pakistan 2009, Vol. 19 (9): 575-578 575 INTRODUCTION Thoracic trauma is a significant source of morbidity and mortality worldwide and accounts for 25-50% of all deaths due to trauma. 1 With a rapid increase in violence in recent years, more thoracic trauma patients are seen in the Accidents and Emergency Departments in public sector hospitals across Pakistan. 2 According to Karmy- Jones et al., 3 thoracotomy will be required in approximately 30% of cases presenting after penetrating chest injury and in 15% after blunt chest trauma. Assessment is required by a trained trauma or thoracic surgeon to decide whether UT is required. A timely decision is of immense importance in saving these patients. Quick transport to a tertiary care hospital (Scoop and run approach) avoiding unnecessary delay in surgery is of utmost importance. 4,5 Ample blood should be available before and during surgery as continuing blood loss has important prognostic implications and a direct relationship to the outcome. 3 This study was carried out to see if an aggressive approach with UT in the management of severe chest trauma can increase the survival rate. METHODOLOGY This study was carried out from January 2005 to June 2007 (30 months) at the Department of Thoracic Surgery, JPMC, Karachi. Massive hemothorax was defined as blood loss through thoracostomy tube amounting to 1500 ml or more on initial thoracostomy, or a continuous loss of 250 ml or more for three consecutive hours. Urgent Thoracotomy (UT) was defined as thoracotomy performed within 48 hours of chest injury. 3,6 Patients aged 12 years or more who had acute, non cardiac thoracic trauma, presenting within 48 hours of sustaining injury, with a Glasgow Coma Score (GCS) > 8, with massive hemothorax were included in the study. Patients in whom UT was indicated but who had co- morbidities directly increasing mortality were excluded from the study. A study specific proforma that included patients’ age, sex, mode of trauma, presentation vitals, time since injury, description of injuries, both thoracic and extra thoracic, resuscitation and specific therapeutic interventions undertaken were recorded. ABSTRACT Objective: To determine the frequency of survival in patients with thoracic trauma, undergoing Urgent Thoracotomy (UT). Study Design: Quasi-experimental study. Place and Duration of Study: The study was carried out in the Department of Thoracic Surgery, JPMC, Karachi, from January 2005 to June 2007 (30 months). Methodology: Fifty two patients, who presented with chest trauma and underwent UT within 48 hours of sustaining thoracic trauma, were included in the study. All patients were assessed by history, physical examination and relevant investigations. Results: A total of 475 patients with acute thoracic trauma needing admission during the study period presented to the Accidents and Emergency Department. Fifty-two (52/475; 10.9%) patients were indicated for UT. The most common indication for UT was massive hemothorax (43/52; 82.6%). The mean age of the patients was 34.36 ± 11.02 years. There were 22 (42.2%) blunt injuries and 30 (57.8%) penetrating injuries. Road Traffic Accidents (RTA) were the most frequent cause of blunt chest injuries (15 patients; 75%), while firearm injury was the commonest (21 patients; 70%) cause of penetrating chest trauma. Post thoracotomy mortality was 13.3 % (4 out of 30) in patients with penetrating injuries and 18.2% (4 out of 22) in patients with blunt injuries (p < 0.01). Mortality of UT was 15.3 % with survival of 84.7%. Overall survival in 475 patients was 95.58%. Conclusion: Early recognition of treatable injuries and an aggressive approach in management with Urgent Thoracotomy can increase chances of survival of patients suffering from severe chest trauma. Key words: Urgent thoracotomy. Thoracic trauma. Thoracostomy. Hemothorax. Department of Thoracic Surgery/*General Surgery, Jinnah Postgraduate Medical Center, Karachi. Correspondence: Dr. Syed Tanveer Ahmad, 2 B/II, Khayaban-e- Hilal, Phase VI, DHA, Karachi. E-mail: tanveerahma@gmail.com Received October 8, 2008; accepted April 29, 2009. Role of Urgent Thoracotomy in Improving the Survival of Patients with Severe Chest Trauma Tanveer Ahmad, Syed Waqar Ahmed, Niaz Hussain and *Muhammad Iqbal Khan ORIGINAL ARTICLE