Penetrating cardiac injuries
| Autor: | Christopher J. Dente, Michael J. Mina, Jacquelyn S. Carr, Jeffrey P. Salomone, Bryan C. Morse, David V. Feliciano, Rashi Jhunjhunwala, Grace S. Rozycki, Jeffrey M. Nicholas, Gary Vercruysse, John U. Zink, Amy D. Wyrzykowski |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Georgia medicine.medical_treatment Wounds Penetrating Trauma registry 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Trauma Centers medicine Humans Registries Thoracotomy Retrospective Studies business.industry Trauma center 030208 emergency & critical care medicine Retrospective cohort study Level iv Emergency department Surgery Heart Injuries Conventional PCI Female Level iii business |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 81:623-631 |
| ISSN: | 2163-0755 |
| Popis: | BACKGROUND This study evaluates patterns of injuries and outcomes from penetrating cardiac injuries (PCIs) at Grady Memorial Hospital, an urban, Level I trauma center in Atlanta, Georgia, over 36 years. METHODS Patients sustaining PCIs were identified from the Trauma Registry of the American College of Surgeons and the Emory Department of Surgery database; data of patients who died prior to any therapy were excluded. Demographics and outcomes were compared over three time intervals: Period 1 (1975-1985; n = 113), Period 2 (1986-1996; n = 79), and Period 3 (2000-2010; n = 79). RESULTS Two hundred seventy-one patients (86% were male; mean age, 33 years; initial base deficit = -11.3 mEq/L) sustained cardiac stab (SW, 60%) or gunshot wounds (GSW, 40%). Emergency department thoracotomy was performed in 67 (25%) of 271 patients. Overall mortality increased in the modern era (Period 1, 27%, vs. Period 2, 22%, vs. Period 3, 42%; p = 0.03) along with GSW mechanisms (Period 1, 32%, vs. Period 2, 33%, vs. Period 3, 57%; p = 0.001), GSW mortality (Period 1, 36%, vs. Period 2, 42%, vs. Period 3, 56%; p = 0.04), and multichamber injuries (Period 1, 12%, vs. Period 2, 10%, vs. Period 3, 34%; p< 0.001). In Period 3, GSWs (n = 45) resulted in multichamber injuries in 28 patients (62%) and multicavity injuries in 19 patients (42%). Surgeon-performed ultrasound accurately identified pericardial blood in 55 of 55 patients in Period 3. CONCLUSIONS Increased frequency of GSWs in the past decade is associated with increased overall mortality, multichamber injuries, and multicavity injuries. Ultrasound is sensitive for detection of PCI. LEVEL OF EVIDENCE Therapeutic study, level IV; epidemioligc study, level III. |
| Databáze: | OpenAIRE |
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