Postdischarge complications after penetrating cardiac injury: A survivable injury with a high postdischarge complication rate

Andrew - Tang, Kenji Inaba, Bernardino C. Branco, Matthew Oliver, Marko Bukur, Ali Salim, Peter M Rhee, Joseph Herrold, Demetrios Demetriades

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Hypothesis: A significant rate of postdischarge complications is associated with penetrating cardiac injuries. Design: Retrospective trauma registry review. Setting: Level I trauma center. Patients: All patients sustaining penetrating cardiac injuries between January 2000 and June 2010. Patient demographics, clinical data, operative findings, outpatient follow-up, echocardiogram results, and outcomes were extracted. Main Outcome Measures: Cardiac-related complications and mortality. Results: During the 10.5-year study period, 406 of 40 706 trauma admissions (1.0%) sustained penetrating cardiac injury. One hundred nine (26.9%) survived to hospital discharge. The survivors were predominantly male (94.4%), with a mean (SD) age of 30.8 (11.7) years, and 74.3% sustained a stab wound. Signs of life were present on admission in 92.6%. Cardiac chambers involved were the right ventricle (45.9%), left ventricle (40.3%), right atrium (10.1%), left atrium (0.9%), and combined (2.8%). Inhospital follow-up was available for a mean (SD) of 11.0 (9.8) days (median, 8 days; range, 3-65 days) and outpatient follow-up was available in 46 patients (42.2%) for a mean (SD) of 1.9 (4.1) months (median, 0.9 months; range, 0.2-12 months). Abnormal echocardiograms demonstrated pericardial effusions (9), abnormal wall motion (8), decreased ejection fraction (<45%) (8), intramural thrombus (4), valve injury (4), cardiac enlargement (2), conduction abnormality (2), pseudoaneurysm (1), aneurysm (1), and septal defect (1). No operative intervention was required for the complications. The 1-year and 9-year survival rates were 97% and 88%, respectively. Conclusions: Penetrating cardiac injuries remain highly lethal. A significant rate of cardiac complications can be expected and follow-up echocardiographic evaluation is warranted prior to discharge. The majority of these, however, can be managed without the need for surgical intervention.

Original languageEnglish (US)
Pages (from-to)1061-1066
Number of pages6
JournalArchives of Surgery
Volume146
Issue number9
DOIs
StatePublished - Sep 2011

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Wounds and Injuries
Heart Atria
Heart Ventricles
Outpatients
Stab Wounds
Pericardial Effusion
Trauma Centers
False Aneurysm
Aneurysm
Survivors
Registries
Thrombosis
Survival Rate
Demography
Outcome Assessment (Health Care)
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Postdischarge complications after penetrating cardiac injury : A survivable injury with a high postdischarge complication rate. / Tang, Andrew -; Inaba, Kenji; Branco, Bernardino C.; Oliver, Matthew; Bukur, Marko; Salim, Ali; Rhee, Peter M; Herrold, Joseph; Demetriades, Demetrios.

In: Archives of Surgery, Vol. 146, No. 9, 09.2011, p. 1061-1066.

Research output: Contribution to journalArticle

Tang, Andrew - ; Inaba, Kenji ; Branco, Bernardino C. ; Oliver, Matthew ; Bukur, Marko ; Salim, Ali ; Rhee, Peter M ; Herrold, Joseph ; Demetriades, Demetrios. / Postdischarge complications after penetrating cardiac injury : A survivable injury with a high postdischarge complication rate. In: Archives of Surgery. 2011 ; Vol. 146, No. 9. pp. 1061-1066.
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abstract = "Hypothesis: A significant rate of postdischarge complications is associated with penetrating cardiac injuries. Design: Retrospective trauma registry review. Setting: Level I trauma center. Patients: All patients sustaining penetrating cardiac injuries between January 2000 and June 2010. Patient demographics, clinical data, operative findings, outpatient follow-up, echocardiogram results, and outcomes were extracted. Main Outcome Measures: Cardiac-related complications and mortality. Results: During the 10.5-year study period, 406 of 40 706 trauma admissions (1.0{\%}) sustained penetrating cardiac injury. One hundred nine (26.9{\%}) survived to hospital discharge. The survivors were predominantly male (94.4{\%}), with a mean (SD) age of 30.8 (11.7) years, and 74.3{\%} sustained a stab wound. Signs of life were present on admission in 92.6{\%}. Cardiac chambers involved were the right ventricle (45.9{\%}), left ventricle (40.3{\%}), right atrium (10.1{\%}), left atrium (0.9{\%}), and combined (2.8{\%}). Inhospital follow-up was available for a mean (SD) of 11.0 (9.8) days (median, 8 days; range, 3-65 days) and outpatient follow-up was available in 46 patients (42.2{\%}) for a mean (SD) of 1.9 (4.1) months (median, 0.9 months; range, 0.2-12 months). Abnormal echocardiograms demonstrated pericardial effusions (9), abnormal wall motion (8), decreased ejection fraction (<45{\%}) (8), intramural thrombus (4), valve injury (4), cardiac enlargement (2), conduction abnormality (2), pseudoaneurysm (1), aneurysm (1), and septal defect (1). No operative intervention was required for the complications. The 1-year and 9-year survival rates were 97{\%} and 88{\%}, respectively. Conclusions: Penetrating cardiac injuries remain highly lethal. A significant rate of cardiac complications can be expected and follow-up echocardiographic evaluation is warranted prior to discharge. The majority of these, however, can be managed without the need for surgical intervention.",
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AU - Tang, Andrew -

AU - Inaba, Kenji

AU - Branco, Bernardino C.

AU - Oliver, Matthew

AU - Bukur, Marko

AU - Salim, Ali

AU - Rhee, Peter M

AU - Herrold, Joseph

AU - Demetriades, Demetrios

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N2 - Hypothesis: A significant rate of postdischarge complications is associated with penetrating cardiac injuries. Design: Retrospective trauma registry review. Setting: Level I trauma center. Patients: All patients sustaining penetrating cardiac injuries between January 2000 and June 2010. Patient demographics, clinical data, operative findings, outpatient follow-up, echocardiogram results, and outcomes were extracted. Main Outcome Measures: Cardiac-related complications and mortality. Results: During the 10.5-year study period, 406 of 40 706 trauma admissions (1.0%) sustained penetrating cardiac injury. One hundred nine (26.9%) survived to hospital discharge. The survivors were predominantly male (94.4%), with a mean (SD) age of 30.8 (11.7) years, and 74.3% sustained a stab wound. Signs of life were present on admission in 92.6%. Cardiac chambers involved were the right ventricle (45.9%), left ventricle (40.3%), right atrium (10.1%), left atrium (0.9%), and combined (2.8%). Inhospital follow-up was available for a mean (SD) of 11.0 (9.8) days (median, 8 days; range, 3-65 days) and outpatient follow-up was available in 46 patients (42.2%) for a mean (SD) of 1.9 (4.1) months (median, 0.9 months; range, 0.2-12 months). Abnormal echocardiograms demonstrated pericardial effusions (9), abnormal wall motion (8), decreased ejection fraction (<45%) (8), intramural thrombus (4), valve injury (4), cardiac enlargement (2), conduction abnormality (2), pseudoaneurysm (1), aneurysm (1), and septal defect (1). No operative intervention was required for the complications. The 1-year and 9-year survival rates were 97% and 88%, respectively. Conclusions: Penetrating cardiac injuries remain highly lethal. A significant rate of cardiac complications can be expected and follow-up echocardiographic evaluation is warranted prior to discharge. The majority of these, however, can be managed without the need for surgical intervention.

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