Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While HIV/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures.
A prospective, observational study at 16 US trauma centers was performed (2015-2016). All bedside EDT resuscitation providers were surveyed with a standardized data collection tool and risk factors analyzed with respect to the primary endpoint, EDT occupational exposure (percutaneous injury, mucous membrane, open wound, or eye splash). Provider, patient variables and outcomes were evaluated with single and multivariable logistic regression analyses.
1360 participants (23% attending, 59% trainee, 11% nurse, 7% other) were surveyed after 305 EDT (GSW 68%, prehospital CPR 57%, ED signs of life 37%) of which 15 patients survived (13 neurologically intact) their hospitalization. Overall, 22 occupational exposures were documented, resulting in an exposure rate of 7.2% (95%CI; 4.7-10.5) per EDT and 1.6% (95%CI; 1.0-2.4) per participant. No differences in trauma center level, number of participants or hours worked were identified. Providers with exposures were primarily trainees (68%) with percutaneous injuries (86%) during the thoracotomy (73%). Full precautions were utilized in only 46% of exposed providers while multiple variable logistic regression determined that each PPE item utilized during EDT correlated with a 34% decreased risk of occupational exposure (OR 0.66; 95%CI 0.48-0.91; p=0.010).
Our results suggest that the risk of occupational exposure should not deter providers from performing EDT. Despite the small risk of viral transmission, our data revealed practices which may place healthcare providers at unnecessary risk for occupational exposure. Regardless of the life-saving nature of the procedure, improved universal precaution compliance with PPE is paramount and would further minimize occupational exposure risks during EDT.
Level III, Therapeutic/Care Management.
Pharmacology, Toxicology and Pharmaceutical Science
3
5%
Computer Science
2
3%
Social Sciences
2
3%
Other
4
6%
Unknown
22
35%
Attention Score in Context
Attention Score in Context
This research output has an Altmetric Attention Score of 32. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 03 December 2020.
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#1,584,331
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Outputs from Journal of Trauma and Acute Care Surgery, The
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Outputs of similar age from Journal of Trauma and Acute Care Surgery, The
#13
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Altmetric has tracked 34,546,575 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 95th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,314 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 11.2. This one has done particularly well, scoring higher than 94% of its peers.
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We're also able to compare this research output to 124 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 89% of its contemporaries.
