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Aumaitre A, Delteil C, Tuchtan L, Piercecchi-Marti MD, Gainnier M, Carvelli J, Boussen S, Bruder N, Heireche F, Florant T, Gaillat F, Lagier D, Porto A, Velly L, Simeone P. Resuscitation and Forensic Factors Influencing Outcome in Penetrating Cardiac Injury. Diagnostics (Basel) 2024; 14:1406. [PMID: 39001296 PMCID: PMC11241016 DOI: 10.3390/diagnostics14131406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Cardiac injury caused by a sharp object is a medical and surgical therapeutic challenge. Mortality risk factors have been identified but there are major discrepancies in the literature. The aim of this study was to analyse the management of victims of penetrating cardiac injuries before and after admission to hospital and the anatomical characteristics of these injuries in order to facilitate diagnosis of the most critical patients. METHODS To carry out this study, we conducted a retrospective analytical study with epidemiological data on victims of penetrating cardiac injuries. We included two types of patients, with those who underwent autopsy in our institution after death from sharp injury to the heart or great vessels and those who survived with treatment in the emergency department or intensive care unit between January 2015 and February 2022. RESULTS We included 30 autopsied patients and 12 survivors aged between 18 and 73 years. Higher mortality was associated with prehospital or in-hospital cardiorespiratory arrest (OR = 4, CI [1.71-9.35]), preoperative mechanical ventilation (OR = 10, CI [1.53-65.41]), preoperative catecholamines (OR = 7, CI [1.12-6.29]), preoperative and perioperative adrenaline (OR = 13, CI [1.98-85.46] and [1.98-85.46]), penetrating cardiac injury (OR = 14, CI [2.10-93.22]), multiple cardiac injuries (OR = 1.5, CI [1.05-2.22]) and an Organ Injury Scaling of the American Association for the Surgery of Trauma (AAST-OIS) score of 5 (OR = 2.9, CI [1.04-8.54]; p = 0.0329) with an AUC-ROC curve value of 0.708 (CI [0.543-0.841]). CONCLUSIONS This study identified risk mortality factors in penetrating cardiac injury patients. These findings can help improve the diagnosis and management of these patients. The AAST-OIS score may be a good tool to diagnose critical patients.
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Affiliation(s)
- Astrid Aumaitre
- Service de Médecine Légale, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
- Faculté de Médecine Secteur Nord 51, Boulevard Pierre Dramard, ADES, Aix Marseille University, 13344 Marseille, CEDEX 15, France
| | - Clémence Delteil
- Service de Médecine Légale, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Lucile Tuchtan
- Service de Médecine Légale, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
- Faculté de Médecine Secteur Nord 51, Boulevard Pierre Dramard, ADES, Aix Marseille University, 13344 Marseille, CEDEX 15, France
| | - Marie-Dominique Piercecchi-Marti
- Service de Médecine Légale, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
- Faculté de Médecine Secteur Nord 51, Boulevard Pierre Dramard, ADES, Aix Marseille University, 13344 Marseille, CEDEX 15, France
| | - Marc Gainnier
- Réanimation des Urgences, Assistance Publique-Hôpitaux de Marseille, CHU La Timone, 13385 Marseille, France
| | - Julien Carvelli
- Réanimation des Urgences, Assistance Publique-Hôpitaux de Marseille, CHU La Timone, 13385 Marseille, France
| | - Salah Boussen
- Département d'Anesthésie-Réanimation, CHU Timone, Aix Marseille University, 13005 Marseille, France
- Faculté de Médecine Secteur Nord 51, Boulevard Pierre Dramard, IFSTTAR, LBA UMR_T 24, Aix Marseille University, 13344 Marseille, CEDEX 15, France
| | - Nicolas Bruder
- Département d'Anesthésie-Réanimation, CHU Timone, Aix Marseille University, 13005 Marseille, France
| | - Fouzia Heireche
- SAMU13, Pôle RUSH, CHU La Timone, AP-HM, 13005 Marseille, France
| | - Thibault Florant
- Department of Public Health, University Hospital of Marseille, 13015 Marseille, France
| | - Françoise Gaillat
- Département d'Anesthésie et Réanimation (SAR 2), CHU La Timone, Assistance Publique des Hôpitaux de Marseille, 13015 Marseille, France
| | - David Lagier
- Département d'Anesthésie et Réanimation (SAR 2), CHU La Timone, Assistance Publique des Hôpitaux de Marseille, 13015 Marseille, France
| | - Alizée Porto
- Département de Chirurgie Cardiaque, CHU Timone, 13005 Marseille, France
| | - Lionel Velly
- Département d'Anesthésie-Réanimation, CHU Timone, Aix Marseille University, 13005 Marseille, France
- Institut des Neurosciences de la Timone, CNRS, Aix Marseille University, 13005 Marseille, France
| | - Pierre Simeone
- Département d'Anesthésie-Réanimation, CHU Timone, Aix Marseille University, 13005 Marseille, France
- Institut des Neurosciences de la Timone, CNRS, Aix Marseille University, 13005 Marseille, France
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Allain C, Godard E, Esperança P, Raul JS, Farrugia A. Fatal penetrating iliac wound: A case report with determination of physical activity and time to collapse. Forensic Sci Int 2023; 342:111537. [PMID: 36529084 DOI: 10.1016/j.forsciint.2022.111537] [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: 09/07/2022] [Revised: 11/17/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
A case of fatal left iliac penetrating wound in a thirty-year-old man, during a fight, was presented. The medical file described a transfixing five-centimeter large wound on the left iliac vein and a puncture wound on the left iliac artery. After performing an autopsy, we concluded that the death was secondary to multivisceral failure, secondary to hemorrhagic shock. The judge investigating the case requested a detailed forensic medical reconstructive opinion focusing on the sequence of events leading to the fatal blow. Our having access to the videorecording and the photographs of the crime scene, added to the testimonies of witnesses proved to be a great help to the investigation. The data from the crime scene video recordings allowed us to estimate the victim's physical activity after the fatal stabbing (running between 20 and 140 meters) and the time when he collapsed (between 32s and 1 min) after the stabbing which is rarely described with methods using Closed-Circuit Television material, especially in cases of fatal vascular injuries. Those data are usually estimated from eyewitnesses' accounts, which remain an unreliable method.
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Affiliation(s)
- Charlotte Allain
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085 Strasbourg Cedex, France.
| | - Estelle Godard
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085 Strasbourg Cedex, France
| | - Philippe Esperança
- Forensic Analysis Laboratory, 2 rue Henri Barbusse, 13001 Marseille, France
| | - Jean Sébastien Raul
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085 Strasbourg Cedex, France
| | - Audrey Farrugia
- Institute of Legal Medicine, Hospital of Strasbourg, University of Strasbourg, 11, rue Humann, 67085 Strasbourg Cedex, France
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A hard way to die: when multiple lethal gunshots mean suicide. Int J Legal Med 2021; 136:179-187. [PMID: 34698912 DOI: 10.1007/s00414-021-02728-3] [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: 06/25/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
Multiple suicidal gunshot wounds are rare and often present a challenging issue for forensic pathologists in determining the manner of death.We describe three cases of suicidal multiple gunshot wounds in which crime scene investigation, cadaveric examination, and autopsy were provided. In all cases, integration of circumstantial data and crime scene investigation suggested a suicidal event.Firstly, we describe the self-infliction of two gunshots to the chest and head in a 90-year-old man by a revolver with wounds to the left lung and lethal wound to both frontal and temporal lobes. The second case concerns a 97-year-old man found dead with two gunshot wounds to the chest by a semi-automatic weapon and bullets penetrated to the left lung and heart. The last case, exceptional in literature, is a 41-year-old man with three self-inflicted gunshots, all-penetrating the left lung and the heart, using a revolver. This paper illustrates that immediate incapacitation can lack even in case of multiple fatal gunshot wounds on instantaneously lethal targets. Therefore, a complete investigation is required for a correct interpretation of the manner of death.An extensive review of literature is also provided.
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