One hundred five penetrating cardiac injuries: A 2-year prospective evaluation

Juan A. Asensio, John D. Berne, Demetrios Demetriades, Linda Chan, James Murray, Andres Falabella, Hugo Gomez, Santiago Chahwan, George Velmahos, Edward E. Cornwell, Howard Belzberg, William Shoemaker, Thomas V. Berne

Research output: Contribution to journalArticle

151 Citations (Scopus)

Abstract

Objectives: To analyze the parameters measured in the field, during transport, and upon arrival of the physiologic condition of patients sustaining penetrating cardiac injuries, along with the Cardiovascular Respiratory Score (CVRS) component of the Trauma Score, the mechanism and anatomical site of injury, operative characteristics, and cardiac rhythm as predictors of outcome. We also set out to identify a set of patient characteristics that best predict mortality outcome and to correlate cardiac injury grade as determined by the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) with mortality. Methods: This report was a prospective study at American College of Surgeons Level I urban trauma center. Interventions included thoracotomy, sternotomy, or both, for resuscitation and definitive repair of cardiac injury. The main outcome measures used were those parameters measuring physiologic condition of patients, CVRS, mechanism and anatomical site of injury, mortality, and grade of injury. Results: A total of 105 patients sustained penetrating cardiac injuries: 68 injuries (65%) were gunshot wounds and 37 injuries (35%) were stab wounds. The mean Injury Severity Score was 36. Of the 105 wounds, 23 wounds (22%) involved multiple-chamber injuries. The overall survival was 35 of 105 patients (33%): survival of gunshot wound victims was 11 of 68 patients (16%); survival of stab wound victims was 24 of 37 patients (65%). Emergency department thoracotomy was performed in 71 of the 105 patients (68%) with 10 survivors (14%). CVRS: 94% mortality (50 of 53) when CVRS = 0, 89% mortality (57 of 64) when CVRS = 0 to 3, and 31% mortality (12 of 39) when CVRS 4 to 11 (p <0.001). The presence of sinus rhythm when pericardium was opened predicted survival (p <0.001). Anatomical site of injury (injured chamber) and the presence of tamponade did not predict survival. Stepwise logistic regression analysis identified gunshot wound, exsanguination, and restoration of blood pressure as most predictive variables of mortality. AAST-OIS injury grade and mortality: grade I, 0 of 1 (0%); grade II, 1 of 2 (50%); grade III, 2 of 3 (66%); grade IV, 28 of 50 (56%); grade V, 29 of 38 (76%); grade VI, 10 of 11 (91%). Overall incidence: grades IV-VI, 99 of 105 (94%). Conclusions: Parameters measuring physiologic condition, CVRS, and mechanism of injury are significant predictors of outcome in penetrating cardiac injuries. AAST-OIS injury grades I-III are rare in penetrating cardiac trauma. AAST-OIS Injury grades IV-VI are common in penetrating cardiac trauma and accurately predict outcome.

Original languageEnglish
Pages (from-to)1073-1082
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume44
Issue number6
DOIs
StatePublished - 1998
Externally publishedYes

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varespladib methyl
Wounds and Injuries
Mortality
Gunshot Wounds
Survival
Stab Wounds
Thoracotomy
Exsanguination

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

One hundred five penetrating cardiac injuries : A 2-year prospective evaluation. / Asensio, Juan A.; Berne, John D.; Demetriades, Demetrios; Chan, Linda; Murray, James; Falabella, Andres; Gomez, Hugo; Chahwan, Santiago; Velmahos, George; Cornwell, Edward E.; Belzberg, Howard; Shoemaker, William; Berne, Thomas V.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 44, No. 6, 1998, p. 1073-1082.

Research output: Contribution to journalArticle

Asensio, JA, Berne, JD, Demetriades, D, Chan, L, Murray, J, Falabella, A, Gomez, H, Chahwan, S, Velmahos, G, Cornwell, EE, Belzberg, H, Shoemaker, W & Berne, TV 1998, 'One hundred five penetrating cardiac injuries: A 2-year prospective evaluation', Journal of Trauma - Injury, Infection and Critical Care, vol. 44, no. 6, pp. 1073-1082. https://doi.org/10.1097/00005373-199806000-00022
Asensio, Juan A. ; Berne, John D. ; Demetriades, Demetrios ; Chan, Linda ; Murray, James ; Falabella, Andres ; Gomez, Hugo ; Chahwan, Santiago ; Velmahos, George ; Cornwell, Edward E. ; Belzberg, Howard ; Shoemaker, William ; Berne, Thomas V. / One hundred five penetrating cardiac injuries : A 2-year prospective evaluation. In: Journal of Trauma - Injury, Infection and Critical Care. 1998 ; Vol. 44, No. 6. pp. 1073-1082.
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abstract = "Objectives: To analyze the parameters measured in the field, during transport, and upon arrival of the physiologic condition of patients sustaining penetrating cardiac injuries, along with the Cardiovascular Respiratory Score (CVRS) component of the Trauma Score, the mechanism and anatomical site of injury, operative characteristics, and cardiac rhythm as predictors of outcome. We also set out to identify a set of patient characteristics that best predict mortality outcome and to correlate cardiac injury grade as determined by the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) with mortality. Methods: This report was a prospective study at American College of Surgeons Level I urban trauma center. Interventions included thoracotomy, sternotomy, or both, for resuscitation and definitive repair of cardiac injury. The main outcome measures used were those parameters measuring physiologic condition of patients, CVRS, mechanism and anatomical site of injury, mortality, and grade of injury. Results: A total of 105 patients sustained penetrating cardiac injuries: 68 injuries (65{\%}) were gunshot wounds and 37 injuries (35{\%}) were stab wounds. The mean Injury Severity Score was 36. Of the 105 wounds, 23 wounds (22{\%}) involved multiple-chamber injuries. The overall survival was 35 of 105 patients (33{\%}): survival of gunshot wound victims was 11 of 68 patients (16{\%}); survival of stab wound victims was 24 of 37 patients (65{\%}). Emergency department thoracotomy was performed in 71 of the 105 patients (68{\%}) with 10 survivors (14{\%}). CVRS: 94{\%} mortality (50 of 53) when CVRS = 0, 89{\%} mortality (57 of 64) when CVRS = 0 to 3, and 31{\%} mortality (12 of 39) when CVRS 4 to 11 (p <0.001). The presence of sinus rhythm when pericardium was opened predicted survival (p <0.001). Anatomical site of injury (injured chamber) and the presence of tamponade did not predict survival. Stepwise logistic regression analysis identified gunshot wound, exsanguination, and restoration of blood pressure as most predictive variables of mortality. AAST-OIS injury grade and mortality: grade I, 0 of 1 (0{\%}); grade II, 1 of 2 (50{\%}); grade III, 2 of 3 (66{\%}); grade IV, 28 of 50 (56{\%}); grade V, 29 of 38 (76{\%}); grade VI, 10 of 11 (91{\%}). Overall incidence: grades IV-VI, 99 of 105 (94{\%}). Conclusions: Parameters measuring physiologic condition, CVRS, and mechanism of injury are significant predictors of outcome in penetrating cardiac injuries. AAST-OIS injury grades I-III are rare in penetrating cardiac trauma. AAST-OIS Injury grades IV-VI are common in penetrating cardiac trauma and accurately predict outcome.",
author = "Asensio, {Juan A.} and Berne, {John D.} and Demetrios Demetriades and Linda Chan and James Murray and Andres Falabella and Hugo Gomez and Santiago Chahwan and George Velmahos and Cornwell, {Edward E.} and Howard Belzberg and William Shoemaker and Berne, {Thomas V.}",
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T2 - A 2-year prospective evaluation

AU - Asensio, Juan A.

AU - Berne, John D.

AU - Demetriades, Demetrios

AU - Chan, Linda

AU - Murray, James

AU - Falabella, Andres

AU - Gomez, Hugo

AU - Chahwan, Santiago

AU - Velmahos, George

AU - Cornwell, Edward E.

AU - Belzberg, Howard

AU - Shoemaker, William

AU - Berne, Thomas V.

PY - 1998

Y1 - 1998

N2 - Objectives: To analyze the parameters measured in the field, during transport, and upon arrival of the physiologic condition of patients sustaining penetrating cardiac injuries, along with the Cardiovascular Respiratory Score (CVRS) component of the Trauma Score, the mechanism and anatomical site of injury, operative characteristics, and cardiac rhythm as predictors of outcome. We also set out to identify a set of patient characteristics that best predict mortality outcome and to correlate cardiac injury grade as determined by the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) with mortality. Methods: This report was a prospective study at American College of Surgeons Level I urban trauma center. Interventions included thoracotomy, sternotomy, or both, for resuscitation and definitive repair of cardiac injury. The main outcome measures used were those parameters measuring physiologic condition of patients, CVRS, mechanism and anatomical site of injury, mortality, and grade of injury. Results: A total of 105 patients sustained penetrating cardiac injuries: 68 injuries (65%) were gunshot wounds and 37 injuries (35%) were stab wounds. The mean Injury Severity Score was 36. Of the 105 wounds, 23 wounds (22%) involved multiple-chamber injuries. The overall survival was 35 of 105 patients (33%): survival of gunshot wound victims was 11 of 68 patients (16%); survival of stab wound victims was 24 of 37 patients (65%). Emergency department thoracotomy was performed in 71 of the 105 patients (68%) with 10 survivors (14%). CVRS: 94% mortality (50 of 53) when CVRS = 0, 89% mortality (57 of 64) when CVRS = 0 to 3, and 31% mortality (12 of 39) when CVRS 4 to 11 (p <0.001). The presence of sinus rhythm when pericardium was opened predicted survival (p <0.001). Anatomical site of injury (injured chamber) and the presence of tamponade did not predict survival. Stepwise logistic regression analysis identified gunshot wound, exsanguination, and restoration of blood pressure as most predictive variables of mortality. AAST-OIS injury grade and mortality: grade I, 0 of 1 (0%); grade II, 1 of 2 (50%); grade III, 2 of 3 (66%); grade IV, 28 of 50 (56%); grade V, 29 of 38 (76%); grade VI, 10 of 11 (91%). Overall incidence: grades IV-VI, 99 of 105 (94%). Conclusions: Parameters measuring physiologic condition, CVRS, and mechanism of injury are significant predictors of outcome in penetrating cardiac injuries. AAST-OIS injury grades I-III are rare in penetrating cardiac trauma. AAST-OIS Injury grades IV-VI are common in penetrating cardiac trauma and accurately predict outcome.

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