Penetrating cardiac trauma at an urban trauma center: A 22-year perspective

Vinod H. Thourani, David V. Feliciano, William A. Cooper, Kevin M. Brady, Andrew B. Adams, Grace Rozycki, Panagiotis N. Symbas

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)811-818
Number of pages8
JournalAmerican Surgeon
Volume65
Issue number9
StatePublished - Jan 1 1999
Externally publishedYes

Fingerprint

Trauma Centers
Wounds and Injuries
Stab Wounds
Mortality
Emergencies
Pericardiocentesis
Gunshot Wounds
Cardiac Tamponade
Thoracostomy
Blood Pressure
Survival
Pericardial Effusion
Pericardium

ASJC Scopus subject areas

  • Surgery

Cite this

Thourani, V. H., Feliciano, D. V., Cooper, W. A., Brady, K. M., Adams, A. B., Rozycki, G., & Symbas, P. N. (1999). Penetrating cardiac trauma at an urban trauma center: A 22-year perspective. American Surgeon, 65(9), 811-818.

Penetrating cardiac trauma at an urban trauma center : A 22-year perspective. / Thourani, Vinod H.; Feliciano, David V.; Cooper, William A.; Brady, Kevin M.; Adams, Andrew B.; Rozycki, Grace; Symbas, Panagiotis N.

In: American Surgeon, Vol. 65, No. 9, 01.01.1999, p. 811-818.

Research output: Contribution to journalArticle

Thourani, VH, Feliciano, DV, Cooper, WA, Brady, KM, Adams, AB, Rozycki, G & Symbas, PN 1999, 'Penetrating cardiac trauma at an urban trauma center: A 22-year perspective', American Surgeon, vol. 65, no. 9, pp. 811-818.
Thourani VH, Feliciano DV, Cooper WA, Brady KM, Adams AB, Rozycki G et al. Penetrating cardiac trauma at an urban trauma center: A 22-year perspective. American Surgeon. 1999 Jan 1;65(9):811-818.
Thourani, Vinod H. ; Feliciano, David V. ; Cooper, William A. ; Brady, Kevin M. ; Adams, Andrew B. ; Rozycki, Grace ; Symbas, Panagiotis N. / Penetrating cardiac trauma at an urban trauma center : A 22-year perspective. In: American Surgeon. 1999 ; Vol. 65, No. 9. pp. 811-818.
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abstract = "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.",
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