Dogs and cats undergoing surgery for penetrating thoracic trauma have high survival despite frequent complications, and imaging may underestimate injury severity
Abstract
Objective
To describe clinical and radiographic findings in dogs and cats with surgically confirmed penetrating thoracic trauma and evaluate associations with outcomes.
Methods
This retrospective, multicenter observational study reviewed records from 5 referral hospitals to identify dogs and cats with surgically confirmed penetrating thoracic trauma between July 1, 2010, and July 31, 2025. Inclusion required thoracic radiographs, surgical reports, and perioperative records.
Results
A total of 86 dogs and 5 cats were identified. Mean animal trauma triage score was higher in nonsurvivors (7.6 ± 2.4; n = 20) than survivors (5.2 ± 2.5; 71). Radiographic findings included pneumothorax (73.6%), pulmonary contusions (65.9%), and rib fractures (62.6%). Computed tomography findings often identified more injuries. Time from presentation to surgery did not differ in survivors versus nonsurvivors. Lung lobectomy was performed in 24.2% of patients and was more common in nonsurvivors (45.0% vs 18.3%). Intra- and postoperative complications occurred in 56% and 51.7% of patients, respectively. Survival to discharge was 78.0% (71 of 91 patients), with a median hospitalization of 3.3 days (range, 1 to 12 days). Among 55 patients with follow up, 11 (20%) had complications related to thoracic trauma.
Conclusions
Surgical management of penetrating thoracic trauma was associated with a high survival rate despite frequent complications. Animal trauma triage is a useful prognostic indicator. Computed tomography may alter treatment plans.
Clinical Relevance
Clinicians should anticipate higher injury severity than anticipated based on routine imaging and examination. Higher animal trauma triage scores were associated with nonsurvival and may provide useful prognostic information. Close monitoring is needed following surgery for penetrating thoracic trauma.
Keywords: penetrating thoracic trauma; emergency; canine; feline; soft tissue surgery
Introduction
Trauma is estimated to represent 12% of all admissions to small animal veterinary emergency rooms.1,2 Canine and feline patients with traumatic injuries are frequently affected in the thoracic region,1,3 but it is often difficult to adequately assess the extent of their injuries. Thoracic trauma can occur secondary to blunt or penetrating injury, with bite wounds or other animal interactions being the leading cause of penetrating trauma.1 One study1 reported that 17% to 60% of canine and feline patients with penetrating injuries have damage to deeper structures, which is not always reflected by the extent of external injuries. It is suspected that due to the high skin mobility and elasticity of dogs and cats, external wounds may not provide an accurate representation of the full extent of underlying injury.4 It is also often difficult to determine on initial presentation if thoracic injuries sustained will require surgical intervention.3
Treatment recommendations are typically based on the presenting history, initial physical examination, and diagnostics, such as bloodwork and radiographic imaging of the thorax. In dogs and cats with thoracic trauma, common physical examination findings include evidence of puncture wounds, swelling, edema, subcutaneous emphysema, flail chest, pseudo–flail chest, abnormal respiratory patterns, muffled lung sounds on auscultation, tachycardia, hypothermia, tachypnea, and hypoxia.1,3 Common radiographic findings included rib fractures, pulmonary contusions, pneumothorax, and pleural effusion.1,3 Cats also may have radiographic evidence of diaphragmatic hernias, sternal fractures, atelectasis, or pneumomediastinum.1 One study4 identified that the presence of > 3 radiographic lesions was associated with the existence of a penetrating wound and need for thoracic exploration. Radiographs are less sensitive than CT at detecting pulmonary lacerations, with radiographic evidence in only 59% of 22 dogs with CT evidence of pulmonary lacerations secondary to trauma in 1 study.5 No specific radiologic finding has been significantly associated with lung parenchyma damage, emphasizing that internal trauma can be missed without surgical exploration.2
The ideal timing of surgical treatment for veterinary patients following thoracic trauma remains unclear. In clinical practice, the decision to proceed with surgery is multifactorial and depends on considerations such as patient stability, extent of injury, response to initial stabilization, and clinician preference.1 A recent study6 of 464 dogs that had emergency soft tissue surgery found that American Society of Anesthesiologists status was associated with morbidity and mortality in dogs, but timing of the emergency surgery was not. To the authors’ knowledge, no current studies have investigated timing of surgical treatment for penetrating thoracic trauma in veterinary patients in relation to outcome.
The objectives of this retrospective study were to describe the clinical presentation, imaging findings, surgical findings, and outcomes of dogs and cats with surgically confirmed penetrating thoracic trauma; evaluate associations between clinical variables and outcome; and determine whether physical examination and thoracic radiographic findings accurately reflected the extent of intraoperative injury.
Methods
Case selection and medical records review
A call for penetrating thoracic trauma cases was sent out through the Society of Veterinary Soft Tissue Surgery email list. Institutions contributing case data included the Schwarzman Animal Medical Center, University of Florida, University of Tennessee, Ontario Veterinary College, and Texas A&M University. A search was performed through the medical record system at each institution for the terms penetrating thoracic trauma, penetrating thoracic wound, thoracic wound, thoracic trauma, and intrathoracic trauma appearing between July 1, 2010, and July 31, 2025. One investigator from each institution recorded data.
Inclusion criteria included dogs and cats of any age and breed presented for evaluation of trauma that were ultimately confirmed to have penetrating thoracic injuries. For the purposes of this study, a penetrating thoracic injury was defined as a wound with documented communication between the external thorax and the pleural cavity, confirmed during surgical exploration. Patients were required to have thoracic radiographs, surgical exploration of the trauma, and complete medical records containing thoracic radiograph reports, surgical reports, perioperative and postoperative medical therapies, and outcome data. No animals were excluded based on species, signalment, health status, previous treatments, or diagnostic testing. Medical records identified through the search strategy were reviewed to confirm eligibility, and cases were excluded if they lacked thoracic radiographs, surgical confirmation of penetrating thoracic trauma, or complete medical records.
Case information collected included signalment, date of presentation, estimated time elapsed from injury to time of presentation, cause of trauma, physical examination findings at time of presentation, preoperative bloodwork findings, initial diagnostic findings if performed (pulse oximetry, electrocardiography, blood pressure, thoracic point-of-care ultrasound), findings on thoracic radiograph, CT findings if performed, preoperative treatments if performed (wound care, bandage placement, thoracocentesis, chest tube placement and production, fluid therapy, administration of analgesics and antibiotics), surgical findings, postoperative treatments if performed (chest tube placement and production, fluid therapy, administration of analgesics and antibiotics), outcome, complications, and follow-up. Tachypnea was defined as a respiratory rate > 30 breaths/min, based on published reference data indicating that healthy dogs and cats rarely exceed this rate at rest or while sleeping.7,8 Tachycardia was defined as > 200 beats/min for feline patients and > 140 beats/min for canine patients.9 Hypothermia was defined as a rectal temperature < 100 °F (37.8 °C).7 Animal trauma triage (ATT) scores were calculated for each case retrospectively with available information by 1 investigator (NP).9
Intraoperative complications were graded as follows: grade 1 (self-resolving), grade 2 (single intervention such as a fluid bolus, single anticholinergic or vasopressor dose, temporary oxygen supplementation, or active warming), grade 3 (sustained intervention such as a vasopressor constant-rate infusion or blood-product administration), or grade 4 (life-threatening and resulting in intraoperative cardiac arrest). This grading scheme is an adaptation of a previously published Veterinary Cooperative Oncology Group–Common Terminology Criteria for Adverse Events (ie, VCOG-CTCAE) system.10 Postoperative complications were graded as follows: level 1 (mild, requiring only minor bedside interventions), 2 (moderate, requiring pharmacologic intervention other than analgesics or antiemetics), 3 (severe, requiring reoperation or development of organ failure), or 4 (death) using Accordion Severity Classification of Postoperative Complications: Contracted Classification criteria.11
Statistical analysis
Data were recorded in Excel, version 16.106 (Microsoft Corp). Descriptive and comparative statistics were calculated in Prism for macOS, version 11.0.0 (GraphPad Software Inc). Continuous data were assessed for normality using the Shapiro-Wilk test and described with mean ± SD (for normally distributed data) or median and IQR (for nonnormally distributed data), as appropriate. Continuous data were compared between groups using a Mann-Whitney U test or unpaired t test, as appropriate based on normality. Categorical data were compared between groups using a Fisher exact test. Because comparisons between survivors and nonsurvivors were performed across multiple variables, a Holm-Šídák correction for multiple comparisons was applied to these P values. Comparisons with a Holm-Šídák–adjusted P value < .05 were considered significant after correction for multiple testing.
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