Penetrating cardiac injuries: A 36-year perspective at an urban, Level i trauma center

Bryan C. Morse, Michael J. Mina, Jacquelyn S. Carr, Rashi Jhunjhunwala, Christopher J. Dente, John U. Zink, Jeffrey M. Nicholas, Amy D. Wyrzykowski, Jeffrey P. Salomone, Gary A. Vercruysse, Grace S. Rozycki, David V. Feliciano

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

BACKGROUND This study evaluates patterns of injuries and outcomes from penetrating cardiac injuries (PCIs) at Grady Memorial Hospital, an urban, Level I trauma center in Atlanta, Georgia, over 36 years. METHODS Patients sustaining PCIs were identified from the Trauma Registry of the American College of Surgeons and the Emory Department of Surgery database; data of patients who died prior to any therapy were excluded. Demographics and outcomes were compared over three time intervals: Period 1 (1975-1985; n = 113), Period 2 (1986-1996; n = 79), and Period 3 (2000-2010; n = 79). RESULTS Two hundred seventy-one patients (86% were male; mean age, 33 years; initial base deficit = -11.3 mEq/L) sustained cardiac stab (SW, 60%) or gunshot wounds (GSW, 40%). Emergency department thoracotomy was performed in 67 (25%) of 271 patients. Overall mortality increased in the modern era (Period 1, 27%, vs. Period 2, 22%, vs. Period 3, 42%; p = 0.03) along with GSW mechanisms (Period 1, 32%, vs. Period 2, 33%, vs. Period 3, 57%; p = 0.001), GSW mortality (Period 1, 36%, vs. Period 2, 42%, vs. Period 3, 56%; p = 0.04), and multichamber injuries (Period 1, 12%, vs. Period 2, 10%, vs. Period 3, 34%; p< 0.001). In Period 3, GSWs (n = 45) resulted in multichamber injuries in 28 patients (62%) and multicavity injuries in 19 patients (42%). Surgeon-performed ultrasound accurately identified pericardial blood in 55 of 55 patients in Period 3. CONCLUSIONS Increased frequency of GSWs in the past decade is associated with increased overall mortality, multichamber injuries, and multicavity injuries. Ultrasound is sensitive for detection of PCI. LEVEL OF EVIDENCE Therapeutic study, level IV; epidemioligc study, level III.

Original languageEnglish (US)
Pages (from-to)623-631
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number4
DOIs
StatePublished - Oct 1 2016

Keywords

  • Cardiac box
  • cardiac injury
  • echocardiogram
  • penetrating cardiac injury
  • surgeon-performed ultrasound
  • thoracotomy

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Morse, B. C., Mina, M. J., Carr, J. S., Jhunjhunwala, R., Dente, C. J., Zink, J. U., Nicholas, J. M., Wyrzykowski, A. D., Salomone, J. P., Vercruysse, G. A., Rozycki, G. S., & Feliciano, D. V. (2016). Penetrating cardiac injuries: A 36-year perspective at an urban, Level i trauma center. Journal of Trauma and Acute Care Surgery, 81(4), 623-631. https://doi.org/10.1097/TA.0000000000001165