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Barbosa Rengifo MM, Garcia AF, Gonzalez-Hada A, Mejia NJ. Evaluating the Shock Index, Revised Assessment of Bleeding and Transfusion (RABT), Assessment of Blood Consumption (ABC) and novel PTTrauma score to predict critical transfusion threshold (CAT) in penetrating thoracic trauma. Sci Rep 2024; 14:13395. [PMID: 38862533 PMCID: PMC11166957 DOI: 10.1038/s41598-024-62579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/20/2024] [Indexed: 06/13/2024] Open
Abstract
The shock index (SI) has been associated with predicting transfusion needs in trauma patients. However, its utility in penetrating thoracic trauma (PTTrauma) for predicting the Critical Administration Threshold (CAT) has not been well-studied. This study aimed to evaluate the prognostic value of SI in predicting CAT in PTTrauma patients and compare its performance with the Assessment of Blood Consumption (ABC) and Revised Assessment of Bleeding and Transfusion (RABT) scores. We conducted a prognostic type 2, single-center retrospective observational cohort study on patients with PTTrauma and an Injury Severity Score (ISS) > 9. The primary exposure was SI at admission, and the primary outcome was CAT. Logistic regression and decision curve analysis were used to assess the predictive performance of SI and the PTTrauma score, a novel model incorporating clinical variables. Of the 620 participants, 53 (8.5%) had more than one CAT. An SI > 0.9 was associated with CAT (adjusted OR 4.89, 95% CI 1.64-14.60). The PTTrauma score outperformed SI, ABC, and RABT scores in predicting CAT (AUC 0.867, 95% CI 0.826-0.908). SI is a valuable predictor of CAT in PTTrauma patients. The novel PTTrauma score demonstrates superior performance compared to existing scores, highlighting the importance of developing targeted predictive models for specific injury patterns. These findings can guide clinical decision-making and resource allocation in the management of PTTrauma.
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Affiliation(s)
- Mario Miguel Barbosa Rengifo
- Department of Surgery, Universidad del Valle, Cl. 4B #36-00, El Sindicato, Cali Valle del Cauca, Cali, Colombia.
- Department of Surgery and Clinical Research Center, Fundación Valle del Lili, Cali, Colombia.
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia.
| | - Alberto F Garcia
- Department of Surgery, Universidad del Valle, Cl. 4B #36-00, El Sindicato, Cali Valle del Cauca, Cali, Colombia
- Department of Surgery and Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
| | - Adolfo Gonzalez-Hada
- Department of Surgery, Universidad del Valle, Cl. 4B #36-00, El Sindicato, Cali Valle del Cauca, Cali, Colombia
| | - Nancy J Mejia
- Department of Surgery, Universidad del Valle, Cl. 4B #36-00, El Sindicato, Cali Valle del Cauca, Cali, Colombia
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Mohammadzadeh A, Khanghah AS, Ojarood MV. Unsuccessful suicidal attempts by sewing needle introducing to chest: Removing 17 ones from the right ventricle and breast tissue in two stages; case report and literature review. Int J Surg Case Rep 2024; 118:109551. [PMID: 38579596 PMCID: PMC11004868 DOI: 10.1016/j.ijscr.2024.109551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Penetrating cardiac injuries among the whole injuries confronting the trauma surgeon is more alarming. The introduction of needles as an attempt to inflict self-injury has rarely been described, so we only found 34 reported cases reviewing the available English literature since 1967. CASE PRESENTATION We have reported a case of a 35-year-old depressed female who had introduced 17 sewing needles through her chest wall, causing myocardial puncture and mastitis; underwent exploratory sternotomy and mammoplasty in two stages and survived. CLINICAL DISCUSSION Penetrating cardiac trauma is rare enough for surgeons to deal with direct injuries by sewing needles. Penetrating wounds in the "cardiac box" anatomic area" should elicit the highest concern for potential cardiac injury. The mentioned region is demarcated superiorly by the clavicles, inferiorly by the xiphoid, and the nipples laterally in an area of the anterior thorax. CONCLUSION Anterior aspect penetrating traumas to the cardiac box myocardial injuries should be in mind, and immediate and proper intervention should be needed. Ventricles, for their anatomical condition, are exposed to be injured.
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Affiliation(s)
- Alireza Mohammadzadeh
- Department of Cardiothoracic Surgery, Imam Hospital, Ardabil University of Medical Sciences, Ardabil, Iran; Imam Hospital, Basij Square, Ardabil, Iran
| | - Ali Samady Khanghah
- Department of Surgery, Fatemi Hospital, Ardabil University of Medical Sciences, Ardabil, Iran; Fatemi hospital, Imam Ave, Ardabil, Iran.
| | - Mohammad Vakili Ojarood
- Fatemi hospital, Imam Ave, Ardabil, Iran; Department of Thoracic Surgery, Fatemi Hospital, Ardabil University of Medical Sciences, Ardabil, Iran.
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3
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Czarkowski BR, Byerly SE, Lenart EK, Kerwin AJ, Filiberto DM. Management of Penetrating Cardiac Injuries With Pericardial Window and Drainage in Select Patients. Am Surg 2023; 89:3110-3113. [PMID: 37501310 DOI: 10.1177/00031348231157815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Management of penetrating chest injuries with a positive pericardial window (PW) are presumed cardiac injuries and traditionally result in sternotomy. However, there is some evidence in the literature that select patients can be managed with PW, lavage, and drainage (PWLD). METHODS All patients with penetrating chest trauma who underwent PW and/or sternotomy over a 5-year period were identified. Patients were stratified by operative intervention [PW + sternotomy vs PWLD] and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of therapeutic sternotomy. RESULTS Of the 146 patients who underwent PW and/or sternotomy included in the study, 126 patients underwent PW, 39 underwent sternotomy, and 10 underwent PWLD. There was no difference in demographics, LOS, ICU LOS, vent days, or mortality in patients who underwent PW + sternotomy, compared to patients who underwent PWLD. In the PWLD group, one patient returned to the OR for recurrent pericardial effusion and no patients required sternotomy. Multivariable logistic regression identified ISS as an independent predictor of therapeutic sternotomy (OR 1.160; 95% CI 1.006-1.338, P = .0616). Interestingly, positive FAST, significant CT findings, and trajectory were not predictors of therapeutic sternotomy. There were 7 patients with a left hemothorax and negative FAST found to have a positive PW and cardiac injury mandating sternotomy and repair. CONCLUSION Penetrating cardiac injury can be managed with PWLD in select patients. Positive FAST, significant findings on CT, and trajectory do not mandate sternotomy. A negative FAST in the setting of a hemothorax does not rule out a cardiac injury.
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Affiliation(s)
- Brian R Czarkowski
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Saskya E Byerly
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Emily K Lenart
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Andrew J Kerwin
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Dina M Filiberto
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
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4
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Rossaint R, Afshari A, Bouillon B, Cerny V, Cimpoesu D, Curry N, Duranteau J, Filipescu D, Grottke O, Grønlykke L, Harrois A, Hunt BJ, Kaserer A, Komadina R, Madsen MH, Maegele M, Mora L, Riddez L, Romero CS, Samama CM, Vincent JL, Wiberg S, Spahn DR. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care 2023; 27:80. [PMID: 36859355 PMCID: PMC9977110 DOI: 10.1186/s13054-023-04327-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. METHODS The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. RESULTS This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. CONCLUSION A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.
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Affiliation(s)
- Rolf Rossaint
- Department of Anaesthesiology, University Hospital Aachen, RWTH, Aachen University, Pauwelsstrasse 30, D-52074, Aachen, Germany.
| | - Arash Afshari
- grid.5254.60000 0001 0674 042XDepartment of Paediatric and Obstetric Anaesthesia, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Bertil Bouillon
- grid.412581.b0000 0000 9024 6397Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Vladimir Cerny
- grid.424917.d0000 0001 1379 0994Department of Anaesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital, J.E. Purkinje University, Socialni pece 3316/12A, CZ-40113 Usti nad Labem, Czech Republic ,grid.4491.80000 0004 1937 116XDepartment of Anaesthesiology and Intensive Care Medicine, Charles University Faculty of Medicine, Simkova 870, CZ-50003 Hradec Králové, Czech Republic
| | - Diana Cimpoesu
- grid.411038.f0000 0001 0685 1605Department of Emergency Medicine, Emergency County Hospital “Sf. Spiridon” Iasi, University of Medicine and Pharmacy ”Grigore T. Popa” Iasi, Blvd. Independentei 1, RO-700111 Iasi, Romania
| | - Nicola Curry
- grid.410556.30000 0001 0440 1440Oxford Haemophilia and Thrombosis Centre, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7HE UK ,grid.4991.50000 0004 1936 8948Radcliffe Department of Medicine, Oxford University, Oxford, UK
| | - Jacques Duranteau
- grid.460789.40000 0004 4910 6535Department of Anesthesiology, Intensive Care and Perioperative Medicine, Assistance Publique Hôpitaux de Paris, Paris Saclay University, 78 rue du Général Leclerc, F-94275 Le Kremlin-Bicêtre Cedex, France
| | - Daniela Filipescu
- grid.8194.40000 0000 9828 7548Department of Cardiac Anaesthesia and Intensive Care, “Prof. Dr. C. C. Iliescu” Emergency Institute of Cardiovascular Diseases, Carol Davila University of Medicine and Pharmacy, Sos Fundeni 256-258, RO-022328 Bucharest, Romania
| | - Oliver Grottke
- grid.1957.a0000 0001 0728 696XDepartment of Anaesthesiology, University Hospital Aachen, RWTH, Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany
| | - Lars Grønlykke
- grid.5254.60000 0001 0674 042XDepartment of Thoracic Anaesthesiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Anatole Harrois
- grid.460789.40000 0004 4910 6535Department of Anesthesiology, Intensive Care and Perioperative Medicine, Assistance Publique Hôpitaux de Paris, Paris Saclay University, 78 rue du Général Leclerc, F-94275 Le Kremlin-Bicêtre Cedex, France
| | - Beverley J. Hunt
- grid.420545.20000 0004 0489 3985Thrombosis and Haemophilia Centre, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH UK
| | - Alexander Kaserer
- grid.412004.30000 0004 0478 9977Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Radko Komadina
- grid.8954.00000 0001 0721 6013Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty, Ljubljana University, Oblakova ulica 5, SI-3000 Celje, Slovenia
| | - Mikkel Herold Madsen
- grid.5254.60000 0001 0674 042XDepartment of Paediatric and Obstetric Anaesthesia, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Marc Maegele
- grid.412581.b0000 0000 9024 6397Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Lidia Mora
- grid.7080.f0000 0001 2296 0625Department of Anaesthesiology, Intensive Care and Pain Clinic, Vall d’Hebron Trauma, Rehabilitation and Burns Hospital, Autonomous University of Barcelona, Passeig de la Vall d’Hebron 119-129, ES-08035 Barcelona, Spain
| | - Louis Riddez
- grid.24381.3c0000 0000 9241 5705Department of Surgery and Trauma, Karolinska University Hospital, S-171 76 Solna, Sweden
| | - Carolina S. Romero
- grid.106023.60000 0004 1770 977XDepartment of Anaesthesia, Intensive Care and Pain Therapy, Consorcio Hospital General Universitario de Valencia, Universidad Europea of Valencia Methodology Research Department, Avenida Tres Cruces 2, ES-46014 Valencia, Spain
| | - Charles-Marc Samama
- Department of Anaesthesia, Intensive Care and Perioperative Medicine, GHU AP-HP Centre - Université Paris Cité - Cochin Hospital, 27 rue du Faubourg St. Jacques, F-75014 Paris, France
| | - Jean-Louis Vincent
- grid.4989.c0000 0001 2348 0746Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
| | - Sebastian Wiberg
- grid.5254.60000 0001 0674 042XDepartment of Thoracic Anaesthesiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Donat R. Spahn
- grid.412004.30000 0004 0478 9977Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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Diagnosis of Blood Vessel Stenosis Caused by Arterial Thrombosis of Lower Extremities by Ultrasound Based on the Mobile Information System. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7282192. [PMID: 35256900 PMCID: PMC8898109 DOI: 10.1155/2022/7282192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/10/2022] [Accepted: 02/10/2022] [Indexed: 11/18/2022]
Abstract
The thrombosis process is a multifactorial evolution process that includes many genetic and environmental factors that interact with each other. It refers to the existence of blood deposits in the heart or blood vessel walls or abnormal blood clots in the circulatory blood flow during the survival period of humans or animals for some reason. This article aims to analyze the research of blood vessel stenosis caused by arterial thrombosis of the lower extremities under the diagnosis of cardiac ultrasound based on the mobile information system. This article first introduces the mobile information nursing system and its development process. The mobile nursing information system has experienced three stages of development and is an important application of the further development of science and technology in medical information technology. It also proposes a medical diagnosis method based on SRM on a mobile platform and gives a technical roadmap for heart sound analysis and processing. Then, based on the mobile information system, the formation of arterial thrombosis in the lower extremities was analyzed and discussed in the ultrasound diagnosis of the heart, and the vascular stenosis caused by the arterial thrombosis of the lower extremities was analyzed by imaging. Experimental results show that when there is >50% stenosis or complete occlusion, the CTA false positive is more prominent, especially when the calf artery type is complete stenosis. The main cause is that the circulation of the lower limbs is very poor, the blood entering the blood vessels of the lower limbs is scarce, the capillaries are weakly enhanced, and the quality cannot be improved.
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Surgical exploration for stable patients with penetrating cardiac box injuries: when and how? A cohort of 155 patients from Marseille area. J Trauma Acute Care Surg 2022; 93:394-401. [PMID: 35125446 DOI: 10.1097/ta.0000000000003561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The management of penetrating thoracic injuries in moribund or unstable patients is clearly described in contrast to that of stable patients, particularly for those with a cardiac box injury. This anatomic location suggests a potentially lethal cardiac injury and requires urgent therapeutic decision making. The present study aims at determining when surgical exploration is beneficial for stable patients presenting with penetrating cardiac box injuries (PCBI). METHODS This was a retrospective study of stable civilian patients with PCBI referred to level I trauma centers in the Marseille area between January 2009 and December 2019. Using post-hoc analysis of the management outcomes, patients whose surgery was considered therapeutic (group A) were compared with those surgery was considered non-therapeutic and with non-operated patients (group B). RESULTS A total of 155 patients with PCBI were included, with 88% (n = 137) of stab wound injuries (SW). Overall, surgical exploration was performed in 54% (n = 83), considered therapeutic in 71% (n = 59), and performed by video-assisted thoracoscopy (VATS) in 42% (n = 35) with a conversion rates of 14% (n = 5). Initial extended Fast Assessment with Sonography for Trauma (eFAST) revealed the presence of hemopericardium in 29% (n = 29) in group A vs 9.5% (n = 7) in group B, p = 0.010, and was associated with a negative predictive value of 93% regarding the presence of a cardiac injury. Chest tube flow was significantly higher in patients who required surgery, with a median (IQR) of 600.00 (350.00, 1200.00) mL vs. 300.0 (150.00, 400.00) mL (p = 0.001). CONCLUSION eFAST and chest tube flow are the cornerstones of the management of stable PCBI. Video-assisted thoracoscopy represents an interesting approach to check intra thoracic wounds while minimizing surgical morbidity. LEVEL OF EVIDENCE Level IV, prognostic study.
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González-Hadad A, Ordoñez CA, Parra MW, Caicedo Y, Padilla N, Millán M, García A, Vidal-Carpio JM, Pino LF, Herrera MA, Quintero L, Hernández F, Flórez G, Rodríguez-Holguín F, Salcedo A, Serna JJ, Franco MJ, Ferrada R, Navsaria PH. Damage control in penetrating cardiac trauma. Colomb Med (Cali) 2021; 52:e4034519. [PMID: 34188321 PMCID: PMC8216058 DOI: 10.25100/cm.v52i2.4519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/20/2020] [Accepted: 03/18/2021] [Indexed: 11/15/2022] Open
Abstract
Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.
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Affiliation(s)
- Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Yaset Caicedo
- Fundacion Valle del Lili, Centro de Investigaciones Clinicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundacion Valle del Lili, Centro de Investigaciones Clinicas (CIC), Cali, Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Jenny Marcela Vidal-Carpio
- Hospital General Teofilo Davila, Servicio de Emergencias, Cuenca, Ecuador
- Universidad de Cuenca, Department of Surgery, Cuenca, Ecuador
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Laureano Quintero
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Fabian Hernández
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Guillermo Flórez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - María Josefa Franco
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Ricardo Ferrada
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Pradeep H Navsaria
- University of Cape Town, Faculty of Health Sciences, Groote Schuur Hospital, Trauma Center, Anzio Road, Observatory, Cape Town, South Africa
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Manzano-Nunez R, Gomez A, Espitia D, Sierra-Ruiz M, Gonzalez J, Rodriguez-Narvaez JG, Castillo AC, Gonzalez A, Orjuela J, Orozco-Martin V, Bernal F, Giron F, Rios AC, Carranza P, Gonzalez-Hadad A, García-Perdomo HA, García AF. A meta-analysis of the diagnostic accuracy of chest ultrasound for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. J Trauma Acute Care Surg 2021; 90:388-395. [PMID: 33502150 DOI: 10.1097/ta.0000000000003006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND We performed a systematic review (SR) and meta-analysis (MA) to determine the diagnostic accuracy of chest ultrasound (US) compared with a pericardial window (PW) for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. METHODS A literature search in five databases identified relevant articles for inclusion in this SR and MA. Studies were eligible if they evaluated the diagnostic accuracy of chest US, compared with a PW, for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients presenting with penetrating thoracic trauma. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test accuracy within the bivariate mixed-effects logistic regression modeling framework. RESULTS We included five studies in our SR and MA. These studies included a total of 556 trauma patients. The MA found that, compared with PW, the US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients. The presence of a concomitant left hemothorax was frequent in patients with false-negative results. CONCLUSION This SR and MA found that, compared with PW, US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Caution interpretation of pericardial US results is suggested in the presence of left hemothorax. In these cases, a second diagnostic test should be performed. LEVEL OF EVIDENCE Systematic Review and Meta-analysis, level II.
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Affiliation(s)
- Ramiro Manzano-Nunez
- From the Méderi Hospital Universitario Mayor (R.M.-N., D.E., J.G., J.G.R.-N., A.C.C., A.G., J.O., V.O.-M., F.B., F.G.); Escuela de Medicina y Ciencias de la Salud (R.M.-N., D.E., J.G., J.G.R.-N., A.C.C., A.G., J.O., V.O.-M., F.B., F.G.), Universidad del Rosario, Bogotá, DC; Fundacion Valle del Lili, Clinical Research Center (A.G., M.S.-R.), Cali; Hospital Occidente de Kennedy (A.C.R., P.C.), Bogotá, DC; Sección de Urología, Departamento de Cirugía, (A.G.-H., H.A.G.-P.), Universidad del Valle; and Department of Surgery (A.F.G.), Fundación Valle del Lili, Cali, Colombia
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