1
|
Isaza-Restrepo A, Donoso-Samper A, Benitez E, Martin-Saavedra JS, Toro A, Ariza-Salamanca DF, Arredondo N, Molano-Gonzales N, Pinzon-Rondon AM. Retrospective analysis of 261 autopsies of penetrating cardiac injuries with emphasis on sociodemographic factors. Sci Rep 2023; 13:11563. [PMID: 37463948 DOI: 10.1038/s41598-023-38756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/14/2023] [Indexed: 07/20/2023] Open
Abstract
Penetrating cardiac injuries (PCIs) are highly lethal and several factors are related to its incidence and mortality. While most studies focus on characterizing patients who arrived at a medical facility alive and exploring the relationship between the degree of heart compromise and mortality, our study delved deeper into the topic. This study analyzed 261 autopsy reports from 2017 in Bogotá, Colombia, and characterized the factors surrounding PCI incidence and mortality while emphasizing the role of sociodemographic variables. Of these cases, 247 (94.6%) were males with a mean age of 29.19 ± 9.7 years. Weekends, holidays, and late hours had the highest incidence of PCIs. The victims' deaths occurred at the scene in 66 (25.3%) cases, and 65.1% of the victims died before receiving medical care. Upon admission, patients with vital signs were more likely to have been transported by taxi or a private vehicle. Two or more compromised cardiac chambers, increased time of transportation, trauma occurred in the city outskirts, and gunshot wounds were related to increased mortality. Our data is valuable for surgeons, health system managers, and policy analysts as we conducted a holistic assessment of the anatomical and sociodemographic factors that are closely associated with mortality following a PCI. Surgeons must recognize that PCIs can occur even when the entrance wound is outside the cardiac box. Reinforcing hospital infrastructure in the outskirts and improving the availability, accuracy, and response time of first responders may lead to improved patient mortality rates.
Collapse
Affiliation(s)
- Andres Isaza-Restrepo
- Medical and Health Sciences Education Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia.
| | - Andrea Donoso-Samper
- Surgery Department, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Elkin Benitez
- Surgery Department, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | | | - Asdhar Toro
- Surgery Department, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Daniel Felipe Ariza-Salamanca
- Medical and Health Sciences Education Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Nora Arredondo
- Instituto Nacional de Medicina Legal y Ciencias Forenses, Bogotá, 111711, Colombia
| | - Nicolas Molano-Gonzales
- Clinical Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Angela Maria Pinzon-Rondon
- Clinical Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| |
Collapse
|
2
|
Sessa F, Cocimano G, Esposito M, Zuccarello P, Scoto E, Mazzeo P, Salerno M. Systematic Review of Penetrating Cardiac Injury by a Firearm: Forensic Implications. Healthcare (Basel) 2023; 11:265. [PMID: 36673633 PMCID: PMC9859264 DOI: 10.3390/healthcare11020265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Penetrating injuries of the heart, named penetrating cardiac injury (PCI), may cause hemorrhagic shock as well as cardiac tamponade, leading to death if not treated immediately. This systematic review aims to highlight the main aspects of penetrating cardiac injuries after firearm wounds. The cases of 39 subjects (age 37.05 + 15.4) were selected (6 fatal cases). Specifically, 4/39 cases involved subjects under 18 y.o.; analyzing the entrance wound, in 30/39 cases it was located in the anterior chest, 4/39 in the posterior chest, 3/39 in the shoulder/axilla area, 1/39 in the neck, and 1/39 in the pelvis (gluteus). The exit wound was found in only 3/39 cases. Several factors may influence the prognosis: firstly, prompt intervention represents a crucial point, then considering the complications related to PCI, the most important are myocardial infarction, and projectile migration with embolization. The mortality rate is related to: (1) area and severity of the heart injury; (2) duration of transport and intervention; (3) contemporary lesion to other organ/s; (4) the quantity of blood lost; (5) and presence/absence of cardiac tamponade. Based on these findings, a correct approach in the management of PCI may be considered important from a forensic point of view, both as regards to medical liability and from the trial perspective.
Collapse
Affiliation(s)
- Francesco Sessa
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Giuseppe Cocimano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Vanvitelli”, 80121 Napoli, Italy
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Pietro Zuccarello
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Edmondo Scoto
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Pietro Mazzeo
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| |
Collapse
|
3
|
Scagliola R, Seitun S, Rosa GM. Cardiac herniation: A practical review in the emergency setting. Am J Emerg Med 2022; 53:222-227. [DOI: 10.1016/j.ajem.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
|
4
|
Albabtain I, Albargawi A, Almalki SA, Alnasser M. Successful surgical management of a through-and-through right atrial penetrating injury with a complete transaction of the right internal mammary artery: a case report. J Surg Case Rep 2021; 2021:rjaa566. [PMID: 33456750 PMCID: PMC7794022 DOI: 10.1093/jscr/rjaa566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 11/14/2022] Open
Abstract
An injury to the pericardium or the great vessels is considered a true medical emergency, with a poor survival rate. The early identification and immediate response from all the medical services play a significant role in the management of this type of injury. In this case report, we report a young male patient brought to the emergency room (ER) after sustaining two stab wounds to the chest. We present the successful management of the patient from admission to the ER until discharge a few days later, after a successful surgical intervention for a penetrating cardiac injury.
Collapse
Affiliation(s)
- Ibrahim Albabtain
- Department of Surgery, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ali Albargawi
- Department of Surgery, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Sami A Almalki
- Department of Surgery, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Alnasser
- Department of Surgery, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Adigopula S, Medepalli LC. Gunshot-Related Cardiac Trauma: A Multidisciplinary Approach Using Multimodality Imaging. JACC Case Rep 2021; 3:31-33. [PMID: 34319300 PMCID: PMC8305647 DOI: 10.1016/j.jaccas.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Santhi Adigopula
- Division of Cardiology, Department of Medicine, The Heart Center of Northeast Georgia Medical Center, Gainesville, Georgia, USA
| | - Lalitha C. Medepalli
- Noninvasive Cardiology, Northside Hospital Cardiovascular Institute, Northside Hospital, Atlanta, Georgia, USA
| |
Collapse
|
6
|
Eight-year experiences in penetrating cardiac injury: A multi-center retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.729522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
7
|
Tran HV, Charles M, Garrett RC, Kempe PW, Howard CA, Khorgami Z. Ten-Year Trends in Traumatic Cardiac Injury and Outcomes: A Trauma Registry Analysis. Ann Thorac Surg 2020; 110:844-848. [PMID: 32032572 DOI: 10.1016/j.athoracsur.2019.12.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/02/2019] [Accepted: 12/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac injury is a significant cause of death in patients with traumatic injuries. The Oklahoma Trauma Registry collects data from acute care hospitals in Oklahoma. This study investigated the trends and outcomes of traumatic cardiac injury in Oklahoma over a 10-year period. METHODS The Oklahoma Trauma Registry tracks patients with major severity and one of the following criteria: hospital stay 48 hours or longer, death on arrival or in the hospital, hospital transfer, intensive care unit admission, or surgery. Cardiac injuries were identified from data acquired 2005 to 2014. Characteristics, mechanisms of injury, associated injuries, and outcomes were analyzed. Results were further divided into blunt vs penetrating injuries and operative vs nonoperative management. RESULTS Of 107,549 patients, 426 patients suffered cardiac injury, and 160 patients suffered penetrating trauma. Commonly associated injuries were rib fractures, pneumothorax, hemothorax, and intraabdominal injuries. Of blunt cardiac injuries, 26.7% had spinal fractures. Operative management occurred in 16.9%. Overall mortality rate was 35.7% (51.9% in penetrating and 26.3% in blunt injuries). Mortality was higher for patients who had operative management but was similar in penetrating and blunt cardiac injury. Over 10 years, the percentage of cardiac injury decreased. However, mortality in patients who suffered a cardiac injury increased, correlating with an increase in proportion of penetrating cardiac injury. CONCLUSIONS Traumatic cardiac injury, particularly penetrating injury, continues to be a significant source of mortality. Analysis of state-base trauma registries can identify trends in causes of injury and death, serving as a reference point for quality improvement, therapeutic triage, and preventative action plans.
Collapse
Affiliation(s)
- Hoang-Vu Tran
- Department of Surgery, College of Medicine, University of Oklahoma, Tulsa, Oklahoma
| | - Michael Charles
- Department of Surgery, St. John Medical Center, Tulsa, Oklahoma
| | | | - Paul W Kempe
- Department of Surgery, St. John Medical Center, Tulsa, Oklahoma
| | - C Anthony Howard
- Department of Surgery, College of Medicine, University of Oklahoma, Tulsa, Oklahoma.
| | - Zhamak Khorgami
- Department of Surgery, College of Medicine, University of Oklahoma, Tulsa, Oklahoma
| |
Collapse
|
8
|
Abstract
Stab wound in right ventricle of heart requires a prompt and focused surgical intervention. Cardiac tamponade is a common finding when dealing with stabbed hearts, which must be diagnosed and treated in a timely fashion. We report a case of 28-year-old man who presented in emergency department following accidental stab trauma during a religious ceremony. The challenges faced in the perioperative period were the management of impending cardiac tamponade and hemodynamic stability.
Collapse
Affiliation(s)
- Muhammad Saad Yousuf
- Anaesthesia Department, Aga Khan University Hospital (AKUH), P.O. Box. 3500. Stadium Road, Karachi, Pakistan
| | - Hameed Ullah
- Anaesthesia Department, Aga Khan University Hospital (AKUH), P.O. Box. 3500. Stadium Road, Karachi, Pakistan
| |
Collapse
|
9
|
|
10
|
|
11
|
Penetrating cardiac trauma: analysis of 240 cases from a hospital in Bogota, Colombia. World J Emerg Surg 2017; 12:26. [PMID: 28616061 PMCID: PMC5469042 DOI: 10.1186/s13017-017-0138-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/01/2017] [Indexed: 11/22/2022] Open
Abstract
Background Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. Methods This is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed. Results The study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120). Conclusions The study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach.
Collapse
|
12
|
Asensio JA, Ogun OA, Petrone P, Perez-Alonso AJ, Wagner M, Bertellotti R, Phillips B, Cornell DL, Udekwu AO. Penetrating cardiac injuries: predictive model for outcomes based on 2016 patients from the National Trauma Data Bank. Eur J Trauma Emerg Surg 2017; 44:835-841. [PMID: 28578468 DOI: 10.1007/s00068-017-0806-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penetrating cardiac injuries are uncommon and lethal. The objectives of this study are to examine the national profile of cardiac injuries, identify independent predictors of outcome, generate, compare and validate previous predictive models for outcomes. We hypothesized that National Trauma Data Bank (NTDB) given its large number of patients, would validate these models. METHODS The NTDB was queried for data on cardiac injuries, using survival as the main outcome measure. Statistical analysis was performed utilizing univariate and stepwise logistic regression. The stepwise logistic regression model was then compared with other predictive models of outcome. RESULTS There were 2016 patients with penetrating cardiac injuries identified from 1,310,720 patients. Incidence: 0.16%. Mechanism of injury: GSWs-1264 (63%), SWs-716 (36%), Shotgun/impalement-19/16 (1%). Mean RTS 1.75, mean ISS 27 ± 23. Overall survival 675 (33%). 830 patients (41%) underwent ED thoracotomy, 47 survived (6%). Survival stratified by mechanism: GSWs 114/1264 (10%), SWs 564/717 (76%). Predictors of outcome for mortality-univariate analysis: vital signs, RTS, ISS, GCS: Field CPR, ED intubation, ED thoracotomy and aortic cross-clamping (p < 0.001). Stepwise logistic regression identified cardiac GSW's (p < 0.001; AOR 26.85; 95% CI 17.21-41.89), field CPR (p = 0.003; AOR 3.65; 95% CI 1.53-8.69), the absence of spontaneous ventilation (p = 0.008; AOR 1.08, 95% CI 1.02-1.14), the presence of an associated abdominal GSW (p = 0.009; AOR 2.58, 95% CI 1.26-5.26) need for ED airway (p = 0.0003 AOR 1386.30; 95% CI 126.0-15251.71) and aortic cross-clamping (p = 0.0003 AOR 0.18; 95% CI 0.11-0.28) as independent predictors for mortality. Overall predictive power of model-93%. CONCLUSION Predictors of outcome were identified. Overall survival rates are lower than prospective studies report. Predictive model from NTDB generated larger number of strong independent predictors of outcomes, correlated and validated previous predictive models.
Collapse
Affiliation(s)
- J A Asensio
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA. .,Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA.
| | - O A Ogun
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - P Petrone
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - A J Perez-Alonso
- Department of Surgery, University of Granada, Granada, Andalucia, Spain
| | - M Wagner
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - R Bertellotti
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - B Phillips
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - D L Cornell
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - A O Udekwu
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
| |
Collapse
|
13
|
Abstract
PURPOSE Traumatic cardiac injury (TCI) is a challenge for trauma surgeons as it provides a short thera- peutic window and the management is often dictated by the underlying mechanism and hemodynamic status. The current study is to evaluate the factors influencing the outcome of TCI. METHODS Prospectively maintained database of TCI cases admitted at a Level-1 trauma center from July 2008 to June 2013 was retrospectively analyzed. Hospital records were reviewed and statistical analysis was performed using the SPSS version 15. RESULTS Out of 21 cases of TCI, 6 (28.6%) had isolated and 15 (71.4%) had associated injuries. Ratio be- tween blunt and penetrating injuries was 2:1 with male preponderance. Mean ISS was 31.95. Thirteen patients (62%) presented with features suggestive of shock. Cardiac tamponade was present in 12 (57%) cases and pericardiocentesis was done in only 6 cases of them. Overall 19 patients underwent surgery. Perioperatively 8 (38.1%) patients developed cardiac arrest and 7 developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality was related to cardiac arrest (p = 0.014), arrhythmia (p = 0.014), and hemorrhagic shock (p =0.04). The diagnostic accuracy of focused assessment by sonography in trauma (FAST) was 95.24%. CONCLUSION High index of clinical suspicion based on the mechanism of injury, meticulous examination by FAST and early intervention could improve the overall outcome.
Collapse
|
14
|
Lustenberger T, Talving P, Lam L, Inaba K, Mohseni S, Smith JA, Demetriades D. Penetrating cardiac trauma in adolescents: a rare injury with excessive mortality. J Pediatr Surg 2013; 48:745-9. [PMID: 23583128 DOI: 10.1016/j.jpedsurg.2012.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 08/15/2012] [Accepted: 08/17/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Penetrating cardiac injuries in pediatric patients are rarely encountered. Likewise, the in-hospital outcome measures following these injuries are poorly described. METHODS All pediatric patients (<18years) sustaining penetrating cardiac injuries between 1/2000 and 12/2010 were retrospectively identified using the trauma registry of an urban level I trauma center. Demographic and admission variables, operative findings, and hospital course were extracted. Outpatient follow-up data were obtained through chart reviews and cardiac-specific imaging studies. RESULTS During the 11-year study period, 32 of the 4569 pediatric trauma admissions (0.7%) sustained penetrating cardiac injuries. All patients were male and the majority suffered stab wounds (81.2%). The mean systolic blood pressure on admission was 28.8±52.9mmHg and the mean ISS was 46.9±27.7. Cardiac chambers involved were the right ventricle (46.9%), the left ventricle (43.8%), and the right atrium (18.8%). Overall, 9 patients (28.1%) survived to hospital discharge. Outpatient follow-up echocardiography was available for 4 patients (44.4%). An abnormal echocardiography result was found in 1 patient, demonstrating hypokinesia and tricuspid regurgitation. CONCLUSIONS Penetrating cardiac trauma is a rare injury in the pediatric population. Cardiac chambers predominantly involved are the right and left ventricles. This injury is associated with a low in-hospital survival (<30%).
Collapse
Affiliation(s)
- Thomas Lustenberger
- Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA 90033, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Xi EP, Zhu J, Zhu SB, Yin GL, Liu Y, Dong YQ, Zhang Y, Xia F. Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. Clinics (Sao Paulo) 2012; 67. [PMID: 23184204 PMCID: PMC3488986 DOI: 10.6061/clinics/2012(11)10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Ventricular septal defects resulting from post-traumatic cardiac injury are very rare. Percutaneous closure has emerged as a method for treating this disorder. We wish to report our experience in three patients who underwent percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. METHODS We treated three patients with post-traumatic ventricular septal defects caused by stab wounds with knives. After the heart wound was repaired, patient examinations revealed ventricular septal defects with pulmonary/systemic flow ratios (Qp/Qs) of over 1.7. The post-traumatic ventricular septal defects were closed percutaneously with a patent ductus arteriosus occluder (Lifetech Scientific (Shenzhen) Co., LTD, Guangdong, China) utilizing standard techniques. RESULTS Post-operative transthoracic echocardiography revealed no residual left-to-right shunt and indicated normal ventricular function. In addition, 320-slice computerized tomography showed that the occluder was well placed and exhibited normal morphology. CONCLUSION Our experiences indicate that closure of a post-traumatic ventricular septal defect using a patent ductus arteriosus occluder is feasible, safe, and effective.
Collapse
Affiliation(s)
- Er-Ping Xi
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command, Wuhan, People's Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Hsia RY, Mahadevan SV, Brundage SI. Penetrating Cardiac Injury from a Wooden Knitting Needle. J Emerg Med 2012; 43:116-9. [DOI: 10.1016/j.jemermed.2010.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 05/20/2010] [Accepted: 06/13/2010] [Indexed: 10/19/2022]
|
17
|
Arslan MM, Colkesen AY, Akcan R, Hilal A, Meral D. Suicide by tapestry needle. J Forensic Leg Med 2007; 14:165-6. [PMID: 17137848 DOI: 10.1016/j.jcfm.2006.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Revised: 01/27/2006] [Accepted: 02/10/2006] [Indexed: 11/15/2022]
Abstract
A case of completed suicide committed by a 46-year-old male by inserting a tapestry needle in his heart is described. Scene investigation findings and autopsy examination revealed signs of self-harm efforts as well as punctures at both forearms and the right and left sides of the neck. The deceased caused a penetrating cardiac injury which resulted in cardiac tamponade.
Collapse
Affiliation(s)
- M M Arslan
- Forensic Medicine, Council Adana Group Administration, Adalet Bakanligi Adli Tip, Kurumu Adana Grup Baskanligi Seyham, Adana, Turkey.
| | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- Betsy J Evans
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | | |
Collapse
|
19
|
Campbell NC, Thomson SR, Muckart DJJ, Meumann CM, Van Middelkoop I, Botha JBC. Review of 1198 cases of penetrating cardiac trauma. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02819.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Parreira JG, Soldá SC, Rasslan S. Análise dos indicadores de hemorragia letal em vítimas de trauma penetrante de tronco admitidas em choque: um método objetivo para selecionar os candidatos ao "controle de danos". Rev Col Bras Cir 2002. [DOI: 10.1590/s0100-69912002000500003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Identificar os indicadores de hemorragia letal em vítimas de trauma penetrante de tronco, admitidas com hipotensão arterial sistêmica e analisar sua aplicabilidade na seleção dos candidatos ao "controle de danos". MÉTODO: Foram analisadas informações sobre 74 vítimas de ferimentos penetrantes exclusivamente de tronco, admitidas com hipotensão arterial sistêmica secundária à hemorragia, que sobreviveram até o tratamento definitivo. Os dados foram coletados prospectivamente durante dois anos. A média etária foi 29,5 + 8 anos, e 62 (83%) pacientes eram do sexo masculino. Trinta e nove (52%) foram vítimas de ferimentos de instrumentos perfurocortantes e 35 (47%), de ferimentos por projéteis de arma de fogo. Houve 23 óbitos (31%), 19 por hemorragia (82,6%). Os que faleceram por hemorragia foram incluídos no grupo H e os outros no grupo O. Foram comparadas diversas variáveis entre os grupos, utilizando-se o teste t de Student (controlado pelo teste de Levene) e a correlação de Spearman, considerando p<0,05 como significativo. RESULTADOS: As variáveis de maior correlação com hemorragia letal foram a pressão arterial sistólica no início da operação (<110mmHg), o pH arterial no início da operação (<7,25), a resposta à infusão endovenosa de líquidos à admissão (choque persistente) e o volume de concentrados de hemácias transfundido durante a operação (>1.200ml). Através de um modelo de regressão logística foi possível calcular o risco de morte por hemorragia baseado na pressão arterial no início da operação e volume de concentrados de hemácias transfundido. CONCLUSÃO: A análise dos indicadores de hemorragia letal fornece dados objetivos para a indicação do "controle de danos".
Collapse
|
21
|
Spencer Netto FAC, Campos JM, Lima LFC, Rivera MACP, Kreimer F, Silveira RK. Fatores prognósticos de mortalidade em pacientes com trauma cardíaco que chegam à sala de cirurgia. Rev Col Bras Cir 2001. [DOI: 10.1590/s0100-69912001000200003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Detectar índices de complicações pós-operatórias e de letalidade, identificando fatores de risco (mecanismo de trauma, sítio da lesão cardíaca, local da intervenção cirúrgica, lesões associadas, necessidade de transfusão e escores anatômicos de trauma) em pacientes com traumatismo cardíaco que apresentavam sinais vitais à admissão na sala de operações. MÉTODO: Realizou-se um estudo descritivo e analítico, de cunho retrospectivo, através dos prontuários de 52 pacientes, submetidos à toracotomia para tratamento de lesões cardíacas penetrantes entre julho/91 e março/97 em um centro de trauma no Nordeste do Brasil. RESULTADOS: O instrumento lesivo mais freqüente foi a arma branca em 28 pacientes (53,85%), seguidos pela arma de fogo em 24 (46,15%). A lesão de ventrículo direito isolada ocorreu em 25 casos (48,08%). As medianas dos escores anatômicos de trauma foram: injury severity score (ISS)=26; penetrating trauma index (PTI)=23; penetrating thoracic trauma index (PTTI)=20; e penetrating cardiac trauma index (PCTI)=15. A taxa de complicação pós-operatória foi de 36,54% e a de letalidade de 13,45%. O sangramento pós-operatório, a necessidade de reoperação e o uso de mais de três concentrados de hemácias aumentaram o risco relativo de morte. Os escores anatômicos de trauma não estiveram associados a aumento do risco relativo de letalidade. CONCLUSÕES: A maioria dos pacientes com lesão cardíaca desta série apresentou bons fatores prognósticos, justificando a baixa taxa de mortalidade observada.
Collapse
|
22
|
Abstract
With the exception of the use of ECG to screen patients for blunt cardiac injury, recent advances in the diagnosis of thoracic trauma involve new technology. Use of surgeon-performed pericardial and pleural ultrasound for the detection of tamponade or hemothorax, TEE or spiral CT to diagnose rupture of the thoracic aorta, and thoracoscopy to evaluate a hemothorax or the integrity of the left hemidiaphragm are all standard techniques in modern trauma centers. In terms of treatment, emergency center thoracotomy is performed more selectively and with the adjunct of staple closure for cardiac wounds. Pulmonotomy is used selectively to control deep lobar hemorrhage and to avoid the need for an emergent lobectomy. Finally, nonoperative management of an intimal tear of the thoracic aorta or delayed operative management of a full-thickness tear in the patient with multiple injuries, using beta-blocker-induced relative hypotension, is rapidly becoming the standard of care throughout the United States.
Collapse
Affiliation(s)
- D V Feliciano
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | |
Collapse
|
23
|
Hewitt PM, Hickman R, Knottenbelt JD. Effect of alcohol intoxication on hemodynamic physiology and outcome in patients with traumatic cardiac tamponade. THE JOURNAL OF TRAUMA 1999; 47:346-51. [PMID: 10452472 DOI: 10.1097/00005373-199908000-00022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol intoxication has a detrimental effect on hypovolemic shock. Our aim, was to study its effects on "pure" cardiac tamponade (i.e., without hypovolemia) in patients with penetrating chest injuries. METHODS Thirty-five intoxicated and 15 nonintoxicated patients (blood alcohol > and < 17 mmol/L) were studied. Initial vital signs (trauma scores), special investigations (hematologic profiles, blood gases, glucose, lactate, and catecholamines), clinical progress (24- and 72-hour acute physiology and chronic health evaluation II scores) and outcome were compared. RESULTS Intoxicated patients were older (p = 0.02) and more tachypneic on admission (p = 0.006), but no other differences were noted. Mortality was proportional to the degree of shock and was greater in patients who had "front-room" thoracotomies (p < 0.001). Despite the higher percentage of intoxicated patients who were "lifeless" or "in extremis" on admission, they fared no worse than nonintoxicated patients. CONCLUSION Alcohol intoxication does not have an adverse affect on traumatic cardiac tamponade.
Collapse
Affiliation(s)
- P M Hewitt
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, South Africa
| | | | | |
Collapse
|
24
|
Gallerani M, Ferrari F, Magenta G, Barboso G, Antonelli AM, Manfredini R. A needle infixed in the heart. Am J Emerg Med 1998; 16:662-3. [PMID: 9827741 DOI: 10.1016/s0735-6757(98)90169-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A 34-year-old man self-fixed a needle into his heart, in the interventricular septum. The foreign body was localized by X-ray, echocardiography, and computed tomography. At surgical opening of the pericardial lamina, the needle was extracted with no need of cutting open the cardiac muscle.
Collapse
Affiliation(s)
- M Gallerani
- Emergency Department, St Anna Hospital, Ferrara, Italy
| | | | | | | | | | | |
Collapse
|
25
|
Asensio JA, Berne JD, Demetriades D, Chan L, Murray J, Falabella A, Gomez H, Chahwan S, Velmahos G, Cornwell EE, Belzberg H, Shoemaker W, Berne TV. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. THE JOURNAL OF TRAUMA 1998; 44:1073-82. [PMID: 9637165 DOI: 10.1097/00005373-199806000-00022] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To analyze the parameters measured in the field, during transport, and upon arrival of the physiologic condition of patients sustaining penetrating cardiac injuries, along with the Cardiovascular Respiratory Score (CVRS) component of the Trauma Score, the mechanism and anatomical site of injury, operative characteristics, and cardiac rhythm as predictors of outcome. We also set out to identify a set of patient characteristics that best predict mortality outcome and to correlate cardiac injury grade as determined by the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) with mortality. METHODS This report was a prospective study at American College of Surgeons Level I urban trauma center. Interventions included thoracotomy, sternotomy, or both, for resuscitation and definitive repair of cardiac injury. The main outcome measures used were those parameters measuring physiologic condition of patients, CVRS, mechanism and anatomical site of injury, mortality, and grade of injury. RESULTS A total of 105 patients sustained penetrating cardiac injuries: 68 injuries (65%) were gunshot wounds and 37 injuries (35%) were stab wounds. The mean Injury Severity Score was 36. Of the 105 wounds, 23 wounds (22%) involved multiple-chamber injuries. The overall survival was 35 of 105 patients (33%): survival of gunshot wound victims was 11 of 68 patients (16%); survival of stab wound victims was 24 of 37 patients (65%). Emergency department thoracotomy was performed in 71 of the 105 patients (68%) with 10 survivors (14%). CVRS: 94% mortality (50 of 53) when CVRS = 0, 89% mortality (57 of 64) when CVRS = 0 to 3, and 31% mortality (12 of 39) when CVRS 4 to 11 (p < 0.001). The presence of sinus rhythm when pericardium was opened predicted survival (p < 0.001). Anatomical site of injury (injured chamber) and the presence of tamponade did not predict survival. Stepwise logistic regression analysis identified gunshot wound, exsanguination, and restoration of blood pressure as most predictive variables of mortality. AAST-OIS injury grade and mortality: grade I, 0 of 1 (0%); grade II, 1 of 2 (50%); grade III, 2 of 3 (66%); grade IV, 28 of 50 (56%); grade V, 29 of 38 (76%); grade VI, 10 of 11 (91%). Overall incidence: grades IV-VI, 99 of 105 (94%). CONCLUSIONS Parameters measuring physiologic condition, CVRS, and mechanism of injury are significant predictors of outcome in penetrating cardiac injuries. AAST-OIS injury grades I-III are rare in penetrating cardiac trauma. AAST-OIS Injury grades IV-VI are common in penetrating cardiac trauma and accurately predict outcome.
Collapse
Affiliation(s)
- J A Asensio
- Department of Surgery, University of Southern California, and the Los Angeles County/University of Southern California Medical Center, Los Angeles 90033-4525, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Campbell NC, Thomson SR, Muckart DJJ, Meumann CM, Van Middelkoop I, Botha JBC. Review of 1198 cases of penetrating cardiac trauma. Br J Surg 1997. [DOI: 10.1002/bjs.1800841225] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
27
|
Affiliation(s)
- R Karmy-Jones
- Division of Trauma/SICU, Henry Ford Hospital, Detroit, MI, USA
| | | | | | | |
Collapse
|
28
|
Suri YV, Garg A, Venugopalan VM, Kapoor S, Tripathi PC, Kochhar HK, Mahajan TR. MILITANCY TRAUMA : PENETRATING AND NONPENETRATING CARDIAC INJURY. Med J Armed Forces India 1997; 53:30-34. [PMID: 28769431 DOI: 10.1016/s0377-1237(17)30641-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Two hundred and eighty patients with serious chest injuries were treated at a service hospital during a period of 41 months. Out of 9 patients who suffered cardiac trauma S had penetrating cardiac injuries, 2 had penetrating pericardial injury and 2 patients had myocardial contusions. Myocardial contusions simulated myocardial infarction. All patients except one had polytrauma, associated injury to the lung or intra-abdominal organs. Early evacuation, resuscitation, high index of suspicion for cardiac injury and prompt surgical intervention were the keys to successful management in these patients. Thoracotomy was performed to repair the myocardial perforation and lacerated lung injuries. Associated infra-abdominal injuries were managed with laparotomy. Two patients died due to lack of cardiopulmonary bypass facilities and resistant cardiac arrhythmias. Seven patients had uneventful recovery.
Collapse
Affiliation(s)
- Y V Suri
- Senior Adviser (Anaesthesiology), Command Hospital Western Command, Chandimandir 134107
| | - A Garg
- Graded Specialist (Surgery), 92 Base Hospital, C/O 56 APO
| | - V M Venugopalan
- Classified Specialist (Anaesthesiology), 92 Base Hospital, C/O 56 APO
| | - S Kapoor
- Graded Specialist (Surgery), 92 Base Hospital, C/O 56 APO
| | - P C Tripathi
- Classified Specialist (Anaesthesiology), 92 Base Hospital, C/O 56 APO
| | - H K Kochhar
- Classified Specialist (Surgery), 92 Base Hospital, C/O 56 APO
| | - T R Mahajan
- Senior Adviser (Anaesthesiology), 92 Base Hospital, C/O 56 APO
| |
Collapse
|
29
|
Nishioka T, Fontana G, Luo H, Berglund H, Kim CJ, Fishbein MC, Siegel RJ. Intracardiac thrombus formation associated with a nonpenetrating gunshot wound of the right ventricular outflow tract demonstrated by transesophageal echocardiography. Am Heart J 1996; 132:1265-7. [PMID: 8969579 DOI: 10.1016/s0002-8703(96)90471-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- T Nishioka
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | | | | | | | | | | |
Collapse
|
30
|
Bowman MR, King RM. Comparison of staples and sutures for cardiorrhaphy in traumatic puncture wounds of the heart. J Emerg Med 1996; 14:615-8. [PMID: 8933324 DOI: 10.1016/s0736-4679(96)00133-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the traditional method for repair of cardiac lacerations using sutures and pledgets (S/P) with repair using a skin stapling device (SSD) performed by emergency medicine residents. In a prospective, randomized, non-blinded animal study, 20 anesthetized mongrel dogs were instrumented and underwent left lateral thoracotomy, pericardiotomy, and cardiac exposure. In set 1, a standardized 8-mm right ventricular stab wound was made with a #10 scalpel; emergency medicine residents then immediately performed emergent cardiorrhaphy by either S/P (n = 5) or SSD (n = 5) technique. In set 2, 10 dogs received standardized 8-mm right ventricular stab wounds followed by repair and then received a second stab wound to the same right ventricle that was subsequently repaired by the same operator using the alternate technique. All dogs were observed for 60 min for gross blood loss, hemodynamic instability, and integrity of repair. The results demonstrate that SSD cardiorrhaphy was significantly faster (29 +/- 11 sec in set 1; 14 +/- 6 sec in set 2) than S/P repair (201 +/- 10 sec in set 1; 196 +/- 59 sec in set 2). No appreciable differences in blood loss or repair integrity were noted in either group. Two operators in the S/P group suffered needle puncture injuries. In conclusion, cardiorrhaphy by SSD is faster to perform, has similar repair integrity, and has less risk of accidental contaminated needle injury than does traditional S/P repair when performed by emergency medicine residents.
Collapse
Affiliation(s)
- M R Bowman
- Toledo Hospital Emergency Medicine Residency Program, St. Vincent Medical Center, Ohio 43608-2691, USA
| | | |
Collapse
|
31
|
Arreola-Risa C, Rhee P, Boyle EM, Maier RV, Jurkovich GG, Foy HM. Factors influencing outcome in stab wounds of the heart. Am J Surg 1995; 169:553-6. [PMID: 7747838 DOI: 10.1016/s0002-9610(99)80217-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The purpose of this study was to identify factors associated with unfavorable outcome following stab wounds to the heart in order to improve selection of patients who may benefit from aggressive resuscitative efforts. METHODS Preoperative and operative variables were reviewed for all patients treated for cardiac stab wounds at a level I trauma center from 1987 to 1993 in an attempt to identify factors influencing survival. RESULTS Twenty-nine (53%) of the 55 patients who were resuscitated following stab wounds to the heart during the study period survived. Although profound hypotension (systolic blood pressure < 40 mm Hg), cardiopulmonary resuscitation, and emergency room thoracotomies were associated with poor outcome, none were uniformly predictive of death. Some patients survived with each of these characteristics. CONCLUSIONS We recommend that all patients suspected of having cardiac stab wounds be fully resuscitated and undergo thoracotomy, as significant survival can be achieved and death is not always the outcome.
Collapse
Affiliation(s)
- C Arreola-Risa
- Department of Surgery, Harborview Medical Center, Seattle, Washington 98104, USA
| | | | | | | | | | | |
Collapse
|
32
|
Saadia R, Levy RD, Degiannis E, Velmahos GC. Penetrating cardiac injuries: clinical classification and management strategy. Br J Surg 1994; 81:1572-5. [PMID: 7827877 DOI: 10.1002/bjs.1800811106] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The management of penetrating cardiac injury is controversial. To facilitate decision making, a simple clinical classification of patients with such an injury is proposed. Five categories are considered: (1) lifeless, (2) critically unstable, (3) cardiac tamponade, (4) thoracoabdominal injury and (5) benign presentation. Investigation, if indicated, and the timing and setting of surgical intervention are discussed for each category.
Collapse
Affiliation(s)
- R Saadia
- Department of Surgery, Baragwanath Hospital, Johannesburg, South Africa
| | | | | | | |
Collapse
|
33
|
Schwengel RH, Bennett SK, Sequeira AJ, White CS, Ziskind AA. Late presentation of left ventricular pseudoaneurysm and ventricular septal defect after surgery for penetrating cardiac injury. Am Heart J 1994; 127:930-2. [PMID: 8154434 DOI: 10.1016/0002-8703(94)90564-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R H Schwengel
- Division of Cardiology, University of Maryland School of Medicine, Baltimore
| | | | | | | | | |
Collapse
|
34
|
Plummer D, Brunette D, Asinger R, Ruiz E. Emergency department echocardiography improves outcome in penetrating cardiac injury. Ann Emerg Med 1992; 21:709-12. [PMID: 1590612 DOI: 10.1016/s0196-0644(05)82784-2] [Citation(s) in RCA: 226] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVES To determine the effect of immediate two-dimensional echocardiography on the time to diagnosis, survival rate, and neurologic outcome of patients with penetrating cardiac injury. DESIGN A ten-year retrospective review. SETTING Regional trauma center serving a population base of 1.25 million with 85,000 visits yearly. TYPE OF PARTICIPANTS All patients presenting to the emergency department with penetrating cardiac injury. MEASUREMENTS AND MAIN RESULTS The records of 49 patients with penetrating cardiac injury were reviewed. Of these, 28 received immediate two-dimensional echocardiography in the ED (echo group) and 21 did not (nonecho group). The probability of survival was derived using TRISS methodology. Differences between groups were determined using either the two sample t-test for parametric data or the Mann-Whitney test for nonparametric data. The overall probability of survival was 33.2%, and the actual survival rate was 81.6%. The probability of survival was 34.2% and 31.8% for the echo group and nonecho group, respectively. The actual survival was 100% in the echo group and 57.1% in the nonecho group. The average time to diagnosis and disposition for surgical intervention was 15.5 +/- 11.4 minutes for the echo group and 42.4 +/- 21.7 minutes for the nonecho group (P less than .001). The Glasgow Outcome Score was 5.0 for the echo group and 4.2 for the nonecho group (P = .007). CONCLUSION Since the introduction of immediate ED two-dimensional echocardiography, the time to diagnosis of penetrating cardiac injury has decreased and both the survival rate and neurologic outcome of survivors has improved.
Collapse
Affiliation(s)
- D Plummer
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | | | | |
Collapse
|
35
|
|