Penetrating Cardiac Trauma at an Urban Trauma Center: A 22-Year Perspective
This is a report of a 22-year experience with penetrating cardiac trauma at a single urban Level I trauma center. We conducted a retrospective chart review supplemented by computerized patient log. Comparisons of mortality between Period 1 (1975–1985; 113 patients) and Period 2 (1986–1996; 79 patien...
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| Veröffentlicht in: | The American surgeon 1999-09, Vol.65 (9), p.811-818 |
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| creator | Thourani, Vinod H. Feliciano, David V. Cooper, William A. Brady, Kevin M. Adams, Andrew B. Rozycki, Grace S. Symbas, Panagiotis N. |
| description | This is a report of a 22-year experience with penetrating cardiac trauma at a single urban Level I trauma center. We conducted a retrospective chart review supplemented by computerized patient log. Comparisons of mortality between Period 1 (1975–1985; 113 patients) and Period 2 (1986–1996; 79 patients) were by χ2 or Fisher's exact tests. Statistical significance was defined as P ≤ 0.05. From 1975 to 1996, 192 patients (mean age, 32 years; 88% male) with penetrating cardiac stab wounds (68%) or gunshot wounds (32%) were treated. The most common initial clinical presentation was cardiac tamponade, and most patients (54%) were hypotensive (systolic blood pressure 30–90 mm Hg). The most common initial intervention in the emergency center was tube thoracostomy. The use of pericardiocentesis as a diagnostic and therapeutic modality in the emergency center virtually disappeared in Period 2, as compared with Period 1. Since 1994, surgeon-performed cardiac ultrasound has been performed and has correctly diagnosed hemopericardium in 12 patients (100% survival). The overall mortality for all patients during the 22-year study interval was 25 per cent and was not significantly different between Period 1 (27%) and Period 2 (22%). The mortality associated with gunshot wounds was increased compared with that of stab wounds. Similarly, mortality for patients who arrested in the emergency center was increased compared with those patients who did not arrest. We conclude: 1) cardiac tamponade is the most common presentation in patients with cardiac wounds; 2) pericardiocentesis in the emergency center has essentially disappeared; 3) surgeon-performed ultrasound of the pericardium should improve survival of future patients who are normotensive or mildly hypotensive; 4) over the last 11 years, there has been a substantial decrease in mortality in patients with stab wounds and a statistically significant decrease in arrested patients; and 5) overall mortality for penetrating cardiac trauma has not changed during the 22-year interval. |
| doi_str_mv | 10.1177/000313489906500903 |
| format | Article |
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We conducted a retrospective chart review supplemented by computerized patient log. Comparisons of mortality between Period 1 (1975–1985; 113 patients) and Period 2 (1986–1996; 79 patients) were by χ2 or Fisher's exact tests. Statistical significance was defined as P ≤ 0.05. From 1975 to 1996, 192 patients (mean age, 32 years; 88% male) with penetrating cardiac stab wounds (68%) or gunshot wounds (32%) were treated. The most common initial clinical presentation was cardiac tamponade, and most patients (54%) were hypotensive (systolic blood pressure 30–90 mm Hg). The most common initial intervention in the emergency center was tube thoracostomy. The use of pericardiocentesis as a diagnostic and therapeutic modality in the emergency center virtually disappeared in Period 2, as compared with Period 1. Since 1994, surgeon-performed cardiac ultrasound has been performed and has correctly diagnosed hemopericardium in 12 patients (100% survival). The overall mortality for all patients during the 22-year study interval was 25 per cent and was not significantly different between Period 1 (27%) and Period 2 (22%). The mortality associated with gunshot wounds was increased compared with that of stab wounds. Similarly, mortality for patients who arrested in the emergency center was increased compared with those patients who did not arrest. We conclude: 1) cardiac tamponade is the most common presentation in patients with cardiac wounds; 2) pericardiocentesis in the emergency center has essentially disappeared; 3) surgeon-performed ultrasound of the pericardium should improve survival of future patients who are normotensive or mildly hypotensive; 4) over the last 11 years, there has been a substantial decrease in mortality in patients with stab wounds and a statistically significant decrease in arrested patients; and 5) overall mortality for penetrating cardiac trauma has not changed during the 22-year interval.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313489906500903</identifier><identifier>PMID: 10484082</identifier><identifier>CODEN: AMSUAW</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Chi-Square Distribution ; Child ; Emergencies ; Female ; Georgia - epidemiology ; Heart failure ; Heart Injuries - diagnostic imaging ; Heart Injuries - epidemiology ; Heart Injuries - surgery ; Humans ; Injuries of the thorax. Foreign bodies. Diseases due to physical agents ; Male ; Medical records ; Medical sciences ; Middle Aged ; Morbidity - trends ; Mortality - trends ; Retrospective Studies ; Trauma centers ; Trauma Centers - statistics & numerical data ; Traumas. Diseases due to physical agents ; Ultrasonography ; Urban Population - statistics & numerical data ; Wounds, Penetrating - diagnostic imaging ; Wounds, Penetrating - epidemiology ; Wounds, Penetrating - surgery</subject><ispartof>The American surgeon, 1999-09, Vol.65 (9), p.811-818</ispartof><rights>1999 Southeastern Surgical Congress</rights><rights>1999 INIST-CNRS</rights><rights>Copyright The Southeastern Surgical Congress Sep 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c395t-55ce126b92e21831b13e5c8d79e5261d4906c39400bfadf9a28b59805cc570b13</citedby><cites>FETCH-LOGICAL-c395t-55ce126b92e21831b13e5c8d79e5261d4906c39400bfadf9a28b59805cc570b13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/000313489906500903$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/000313489906500903$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>309,310,314,776,780,785,786,21798,23909,23910,25118,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1934322$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10484082$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thourani, Vinod H.</creatorcontrib><creatorcontrib>Feliciano, David V.</creatorcontrib><creatorcontrib>Cooper, William A.</creatorcontrib><creatorcontrib>Brady, Kevin M.</creatorcontrib><creatorcontrib>Adams, Andrew B.</creatorcontrib><creatorcontrib>Rozycki, Grace S.</creatorcontrib><creatorcontrib>Symbas, Panagiotis N.</creatorcontrib><title>Penetrating Cardiac Trauma at an Urban Trauma Center: A 22-Year Perspective</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>This is a report of a 22-year experience with penetrating cardiac trauma at a single urban Level I trauma center. We conducted a retrospective chart review supplemented by computerized patient log. Comparisons of mortality between Period 1 (1975–1985; 113 patients) and Period 2 (1986–1996; 79 patients) were by χ2 or Fisher's exact tests. Statistical significance was defined as P ≤ 0.05. From 1975 to 1996, 192 patients (mean age, 32 years; 88% male) with penetrating cardiac stab wounds (68%) or gunshot wounds (32%) were treated. The most common initial clinical presentation was cardiac tamponade, and most patients (54%) were hypotensive (systolic blood pressure 30–90 mm Hg). The most common initial intervention in the emergency center was tube thoracostomy. The use of pericardiocentesis as a diagnostic and therapeutic modality in the emergency center virtually disappeared in Period 2, as compared with Period 1. Since 1994, surgeon-performed cardiac ultrasound has been performed and has correctly diagnosed hemopericardium in 12 patients (100% survival). The overall mortality for all patients during the 22-year study interval was 25 per cent and was not significantly different between Period 1 (27%) and Period 2 (22%). The mortality associated with gunshot wounds was increased compared with that of stab wounds. Similarly, mortality for patients who arrested in the emergency center was increased compared with those patients who did not arrest. We conclude: 1) cardiac tamponade is the most common presentation in patients with cardiac wounds; 2) pericardiocentesis in the emergency center has essentially disappeared; 3) surgeon-performed ultrasound of the pericardium should improve survival of future patients who are normotensive or mildly hypotensive; 4) over the last 11 years, there has been a substantial decrease in mortality in patients with stab wounds and a statistically significant decrease in arrested patients; and 5) overall mortality for penetrating cardiac trauma has not changed during the 22-year interval.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Chi-Square Distribution</subject><subject>Child</subject><subject>Emergencies</subject><subject>Female</subject><subject>Georgia - epidemiology</subject><subject>Heart failure</subject><subject>Heart Injuries - diagnostic imaging</subject><subject>Heart Injuries - epidemiology</subject><subject>Heart Injuries - surgery</subject><subject>Humans</subject><subject>Injuries of the thorax. Foreign bodies. Diseases due to physical agents</subject><subject>Male</subject><subject>Medical records</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morbidity - trends</subject><subject>Mortality - trends</subject><subject>Retrospective Studies</subject><subject>Trauma centers</subject><subject>Trauma Centers - statistics & numerical data</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Ultrasonography</subject><subject>Urban Population - statistics & numerical data</subject><subject>Wounds, Penetrating - diagnostic imaging</subject><subject>Wounds, Penetrating - epidemiology</subject><subject>Wounds, Penetrating - surgery</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp90E1LwzAYAOAgipvTP-BBgoi3unw0beNtFL9w4A7bwVN5m74dHVs3k1bw35uywkTBS0LC834ScsnZHedxPGaMSS7DRGsWKcY0k0dkyJVSgU6EPCbDDgSdGJAz51b-GUaKn5IBZ2ESskQMyesMa2wsNFW9pCnYogJD5xbaDVBoKNR0YXN_9l8p1g3aezqhQgTvCJbO0Lodmqb6xHNyUsLa4UV_j8ji8WGePgfTt6eXdDINjNSqCZQyyEWUa4GCJ5LnXKIySRFrVCLiRejH8TJkLC-hKDWIJFc6YcoYFTOvR-R2n3dntx8tuibbVM7geg01bluXxX5OHosOXv-Cq21ra99bJriItRIi8kjskbFb5yyW2c5WG7BfGWdZt-fs75590FWfuc03WPwI2S_Wg5segDOwLi3UpnIHp2UoRcfGe-ZgiYfu_qn8DakmjlE</recordid><startdate>19990901</startdate><enddate>19990901</enddate><creator>Thourani, Vinod H.</creator><creator>Feliciano, David V.</creator><creator>Cooper, William A.</creator><creator>Brady, Kevin M.</creator><creator>Adams, Andrew B.</creator><creator>Rozycki, Grace S.</creator><creator>Symbas, Panagiotis N.</creator><general>SAGE Publications</general><general>Southeastern Surgical Congress</general><general>SAGE PUBLICATIONS, INC</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>19990901</creationdate><title>Penetrating Cardiac Trauma at an Urban Trauma Center: A 22-Year Perspective</title><author>Thourani, Vinod H. ; Feliciano, David V. ; Cooper, William A. ; Brady, Kevin M. ; Adams, Andrew B. ; Rozycki, Grace S. ; Symbas, Panagiotis N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c395t-55ce126b92e21831b13e5c8d79e5261d4906c39400bfadf9a28b59805cc570b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Chi-Square Distribution</topic><topic>Child</topic><topic>Emergencies</topic><topic>Female</topic><topic>Georgia - epidemiology</topic><topic>Heart failure</topic><topic>Heart Injuries - diagnostic imaging</topic><topic>Heart Injuries - epidemiology</topic><topic>Heart Injuries - surgery</topic><topic>Humans</topic><topic>Injuries of the thorax. Foreign bodies. Diseases due to physical agents</topic><topic>Male</topic><topic>Medical records</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Morbidity - trends</topic><topic>Mortality - trends</topic><topic>Retrospective Studies</topic><topic>Trauma centers</topic><topic>Trauma Centers - statistics & numerical data</topic><topic>Traumas. 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We conducted a retrospective chart review supplemented by computerized patient log. Comparisons of mortality between Period 1 (1975–1985; 113 patients) and Period 2 (1986–1996; 79 patients) were by χ2 or Fisher's exact tests. Statistical significance was defined as P ≤ 0.05. From 1975 to 1996, 192 patients (mean age, 32 years; 88% male) with penetrating cardiac stab wounds (68%) or gunshot wounds (32%) were treated. The most common initial clinical presentation was cardiac tamponade, and most patients (54%) were hypotensive (systolic blood pressure 30–90 mm Hg). The most common initial intervention in the emergency center was tube thoracostomy. The use of pericardiocentesis as a diagnostic and therapeutic modality in the emergency center virtually disappeared in Period 2, as compared with Period 1. Since 1994, surgeon-performed cardiac ultrasound has been performed and has correctly diagnosed hemopericardium in 12 patients (100% survival). The overall mortality for all patients during the 22-year study interval was 25 per cent and was not significantly different between Period 1 (27%) and Period 2 (22%). The mortality associated with gunshot wounds was increased compared with that of stab wounds. Similarly, mortality for patients who arrested in the emergency center was increased compared with those patients who did not arrest. We conclude: 1) cardiac tamponade is the most common presentation in patients with cardiac wounds; 2) pericardiocentesis in the emergency center has essentially disappeared; 3) surgeon-performed ultrasound of the pericardium should improve survival of future patients who are normotensive or mildly hypotensive; 4) over the last 11 years, there has been a substantial decrease in mortality in patients with stab wounds and a statistically significant decrease in arrested patients; and 5) overall mortality for penetrating cardiac trauma has not changed during the 22-year interval.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>10484082</pmid><doi>10.1177/000313489906500903</doi><tpages>8</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Chi-Square Distribution Child Emergencies Female Georgia - epidemiology Heart failure Heart Injuries - diagnostic imaging Heart Injuries - epidemiology Heart Injuries - surgery Humans Injuries of the thorax. Foreign bodies. Diseases due to physical agents Male Medical records Medical sciences Middle Aged Morbidity - trends Mortality - trends Retrospective Studies Trauma centers Trauma Centers - statistics & numerical data Traumas. Diseases due to physical agents Ultrasonography Urban Population - statistics & numerical data Wounds, Penetrating - diagnostic imaging Wounds, Penetrating - epidemiology Wounds, Penetrating - surgery |
| title | Penetrating Cardiac Trauma at an Urban Trauma Center: A 22-Year Perspective |
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