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Cardiac injuries: analysis of an unselected series of 251 cases
V J Henderson1, R S Smith, W R Fry
1Department of Surgery, University of California, Davis-East Bay (Highland General Hospital), Oakland 94602.
Insights
Survival from cardiac trauma is low, especially for penetrating injuries like gunshot wounds (GSW). Emergency room thoracotomy for cardiac injury patients needs re-evaluation based on injury type and vital signs upon arrival.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Cardiology
Background:
- Cardiac injuries pose a significant threat to life.
- Identifying predictors of survival is crucial for optimizing patient outcomes.
Purpose of the Study:
- To identify factors influencing survival and mortality in patients with cardiac injuries.
- To evaluate the effectiveness of emergency room thoracotomy in managing penetrating cardiac trauma.
Main Methods:
- Retrospective analysis of 251 patients treated for cardiac injuries.
- Categorization of injuries into blunt, gunshot wounds (GSW), and stab wounds.
- Logistic regression analysis to identify significant predictors of outcome.
Main Results:
- Overall survival rate was 18.7%; GSW survival was 6.5%, stab wound survival 37.1%, blunt injury survival 40%.
- Patients arriving with vital signs had 62.2% survival versus <1% for those without.
- GSW was the sole predictor for absent vital signs patients; ISS and combined heart injuries predicted outcomes for those with vital signs.
Conclusions:
- The routine use of emergency room thoracotomy for penetrating cardiac injuries requires critical re-examination.
- Prognostic factors differ significantly based on the presence of vital signs and injury mechanism.
Abstract:
Retrospective analysis was performed on the medical records of 251 patients treated for cardiac injuries at Highland General Hospital trauma facility in Alameda County, California, to identify factors that contribute to patient survival and predict death. Thirty-six patients (14%) had blunt injuries, 153 patients (61%) had gunshot wounds (GSW), and 62 patients (25%) had stab wounds. The overall survival rate was 18.7%, GSW survival was 6.5%, stab wound survival was 37.1%, and blunt injury survival was 40%. Patients who arrived with some vital signs had 62.2% survival and patients who arrived with absent vital signs had < 1% survival. Stepwise multiple logistic regression analysis revealed that for patients with absent vital signs the only significant predictor of outcome was GSW as the mechanism of injury and for patients with vital signs the ISS and the presence of combined right and left heart injuries were significant independent predictors of outcome. We conclude that the routine and aggressive use of emergency room thoracotomy for patients with penetrating cardiac injury must be re-examined.