BACKGROUND: Penetrating cardiac injury is a dramatic and lethal form of trauma. The majority of patients will die before reaching medical care, but for those who arrive at hospital alive, the diagnostic acumen and rapid surgical intervention of physicians and surgeons can lead to successful outcomes. MATERIALS AND METHODS: A structured diagnostic and management approach is used in our trauma unit to deal with penetrating cardiac injury. A retrospective study of 117 patients with penetrating trauma to the heart was conducted over 32 months; the purpose of this study was to describe our protocol and review overall outcome with this type of injury. Demographic details, mechanism of injury, and mode of presentation were recorded. Mortality and morbidity data were collated and echocardiographic follow-up was performed. RESULTS: There were 109 male patients, mean age 29 years (range: 15-54 years) and 8 female patients, mean age 35 years (range: 23-56 years). Most patients (96/117) had sustained stab wounds, and the associated mortality was 15.6%. Twenty-one patients had sustained gunshot wounds (GSW), with a mortality of 81%. Gunshot wounds were significantly more likely to result in death (P<or=0.0001). Five patients sustained multiple cardiac wounds, and three of them died. The risk of death was not different between patients sustaining single or multiple cardiac wounds (P=0.11). Eleven patients had thoracoabdominal injury, and 3/11 (27%) died; all of those that died had sustained GSW. The risk of death was not different between patients sustaining thoracoabdominal wounds and those with isolated thoracic injury (P=1.0). Among the 51 patients with stab wounds who presented with cardiac tamponade, the mortality was only 8%. Compared to the other patients with stab wounds, cardiac tamponade conferred a significant survival advantage (P=0.02). CONCLUSIONS: A high index of suspicion for penetrating cardiac injury and an understanding of the modes of presentation can lead to rapid diagnosis even by inexperienced junior staff. Such a structured approach to patients with penetrating trauma to the chest leads to early definitive management and acceptable results.
BACKGROUND: Penetrating cardiac injury is a dramatic and lethal form of trauma. The majority of patients will die before reaching medical care, but for those who arrive at hospital alive, the diagnostic acumen and rapid surgical intervention of physicians and surgeons can lead to successful outcomes. MATERIALS AND METHODS: A structured diagnostic and management approach is used in our trauma unit to deal with penetrating cardiac injury. A retrospective study of 117 patients with penetrating trauma to the heart was conducted over 32 months; the purpose of this study was to describe our protocol and review overall outcome with this type of injury. Demographic details, mechanism of injury, and mode of presentation were recorded. Mortality and morbidity data were collated and echocardiographic follow-up was performed. RESULTS: There were 109 male patients, mean age 29 years (range: 15-54 years) and 8 female patients, mean age 35 years (range: 23-56 years). Most patients (96/117) had sustained stab wounds, and the associated mortality was 15.6%. Twenty-one patients had sustained gunshot wounds (GSW), with a mortality of 81%. Gunshot wounds were significantly more likely to result in death (P<or=0.0001). Five patients sustained multiple cardiac wounds, and three of them died. The risk of death was not different between patients sustaining single or multiple cardiac wounds (P=0.11). Eleven patients had thoracoabdominal injury, and 3/11 (27%) died; all of those that died had sustained GSW. The risk of death was not different between patients sustaining thoracoabdominal wounds and those with isolated thoracic injury (P=1.0). Among the 51 patients with stab wounds who presented with cardiac tamponade, the mortality was only 8%. Compared to the other patients with stab wounds, cardiac tamponade conferred a significant survival advantage (P=0.02). CONCLUSIONS: A high index of suspicion for penetrating cardiac injury and an understanding of the modes of presentation can lead to rapid diagnosis even by inexperienced junior staff. Such a structured approach to patients with penetrating trauma to the chest leads to early definitive management and acceptable results.
Authors: Juan A Asensio; Hector Arroyo; William Veloz; Walter Forno; Esteban Gambaro; Gustavo A Roldan; James Murray; George Velmahos; Demetrios Demetriades Journal: World J Surg Date: 2001-11-22 Impact factor: 3.352
Authors: J A Asensio; B M Stewart; J Murray; A H Fox; A Falabella; H Gomez; A Ortega; C B Fuller; M D Kerstein Journal: Surg Clin North Am Date: 1996-08 Impact factor: 2.741
Authors: Dietrich Doll; Markus Eichler; Pantelis Vassiliu; Kenneth Boffard; Tim Pohlemann; Elias Degiannis Journal: World J Surg Date: 2017-01 Impact factor: 3.352
Authors: Michael Frink; Philipp Mommsen; Hagen Andruszkow; Christian Zeckey; Christian Krettek; Frank Hildebrand Journal: Langenbecks Arch Surg Date: 2011-03-08 Impact factor: 3.445
Authors: Mohd Lateef Wani; Abdul Gani Ahangar; Gh Nabi Lone; Zubair Ashraf Hakeem; Abdul Majeed Dar; Reyaz Ahmad Lone; Mohd Akbar Bhat; Shyam Singh; Ifat Irshad Journal: J Emerg Trauma Shock Date: 2011-04