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Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
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Screening for occult penetrating cardiac injuries
Andrew J Nicol1, Pradeep H Navsaria, Steve Beningfield
1*Trauma Centre, Department of Surgery; and †Department of Radiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Annals of Surgery
|February 10, 2015
Summary
Emergency department ultrasonography (US) shows 86.7% sensitivity for diagnosing cardiac injury after chest trauma. Factors like hemothorax and pneumopericardium limit screening accuracy, necessitating improved protocols for occult injuries.
Area of Science:
- Emergency medicine
- Diagnostic imaging
- Trauma surgery
Background:
- Ultrasonography (US) is widely used for screening cardiac injuries post-penetrating chest trauma.
- US detects hemopericardium, indicating potential cardiac injury.
Purpose of the Study:
- To evaluate the sensitivity of emergency department ultrasonography (US) in diagnosing occult cardiac injuries.
- To identify limitations of US in detecting hemopericardium.
Main Methods:
- Prospective evaluation of hemodynamically stable patients with penetrating chest wounds.
- All patients underwent US followed by subxiphoid pericardial window exploration.
- Study conducted at Groote Schuur Hospital Trauma Centre (Oct 2001-Feb 2009).
Main Results:
- 172 patients included; 166 stab wounds, 6 gunshot wounds.
- US sensitivity for hemopericardium was 86.7%; positive predictive value was 77%.
- 18 false-negatives occurred, often associated with hemothorax or pneumopericardium.
Conclusions:
- US sensitivity for hemopericardium in stable patients is limited (86.7%).
- Hemothorax and pneumopericardium are key factors reducing US screening effectiveness.
- A revised screening protocol is proposed to address these limitations.
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