Shot through the heart: A 17-year analysis of pre-hospital and hospital deaths from penetrating cardiac injuries.

Autor: McNicoll CF; Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States., McNickle AG; Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States., Vanderet D; Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States., Patel PP; Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States., Souchon P; Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States., Kuhls DA; Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States., Fraser DR; Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States., Chestovich PJ; Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States. Electronic address: paul.chestovich@unlv.edu.
Jazyk: angličtina
Zdroj: Injury [Injury] 2023 May; Vol. 54 (5), pp. 1349-1355. Date of Electronic Publication: 2023 Jan 26.
DOI: 10.1016/j.injury.2023.01.046
Abstrakt: Background: Penetrating cardiac injuries (PCI) are often fatal despite rapid transport and treatment in the prehospital setting. Although many studies have identified risk factors for mortality, few studies have included non-transported field mortalities. This study analyzes penetrating cardiac injuries including hospital and coroner reports in the current era.
Methods: Seventeen years of data were reviewed, including the trauma center (TC) registry, medical records, and coroner reports from 2000-2016. PCI were graded using American Association for the Surgery of Trauma (AAST) cardiac organ injury score (COIS). Subjects were divided into three groups: field deaths, hospital deaths, and survivors to hospital discharge. The primary outcome is survival to hospital discharge overall and among those transported to the hospital.
Results: During the study period, 643 PCI patients were identified, with 52 excluded for inadequate data, leaving 591 for analysis. Mean age was 38.1 ± 17.5 years, and survivors (n=66) were significantly younger than field deaths (n=359) (32.6 ± 14.4 vs 41.1 ± 18.5, p<0.001). Stab wounds had higher survival than gunshot wounds (26.6% vs. 4.3%, p<0.001). COIS grades 4 to 6 (n=602) had lower survival than grades 1 to 3 (n=41) (8.3% vs. 39.0%, p<0.001). Survivors (n=66) had lower median COIS than patients who died in hospital (n=218) (4 vs. 5, p<0.001). Single chamber PCI had higher survival than multiple chamber PCI (13% vs. 5%, p=0.004).  The left ventricle is the most injured (n=177), and right ventricle PCI has the highest survival (p<0.001).  Of field deaths, left ventricular injuries had the highest single chamber mortality (60%), equaling multi-chamber PCI (60%).
Conclusions: Survival to both TC evaluation and hospital discharge following PCI is influenced by many factors including age, mechanism, anatomic site, and grade. Despite advances in trauma care, survival has not appreciably improved.
Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare for this work.
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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