TY - JOUR
T1 - Postdischarge complications after penetrating cardiac injury
T2 - A survivable injury with a high postdischarge complication rate
AU - Tang, Andrew L.
AU - Inaba, Kenji
AU - Branco, Bernardino C.
AU - Oliver, Matthew
AU - Bukur, Marko
AU - Salim, Ali
AU - Rhee, Peter
AU - Herrold, Joseph
AU - Demetriades, Demetrios
PY - 2011/9
Y1 - 2011/9
N2 - Hypothesis: A significant rate of postdischarge complications is associated with penetrating cardiac injuries. Design: Retrospective trauma registry review. Setting: Level I trauma center. Patients: All patients sustaining penetrating cardiac injuries between January 2000 and June 2010. Patient demographics, clinical data, operative findings, outpatient follow-up, echocardiogram results, and outcomes were extracted. Main Outcome Measures: Cardiac-related complications and mortality. Results: During the 10.5-year study period, 406 of 40 706 trauma admissions (1.0%) sustained penetrating cardiac injury. One hundred nine (26.9%) survived to hospital discharge. The survivors were predominantly male (94.4%), with a mean (SD) age of 30.8 (11.7) years, and 74.3% sustained a stab wound. Signs of life were present on admission in 92.6%. Cardiac chambers involved were the right ventricle (45.9%), left ventricle (40.3%), right atrium (10.1%), left atrium (0.9%), and combined (2.8%). Inhospital follow-up was available for a mean (SD) of 11.0 (9.8) days (median, 8 days; range, 3-65 days) and outpatient follow-up was available in 46 patients (42.2%) for a mean (SD) of 1.9 (4.1) months (median, 0.9 months; range, 0.2-12 months). Abnormal echocardiograms demonstrated pericardial effusions (9), abnormal wall motion (8), decreased ejection fraction (<45%) (8), intramural thrombus (4), valve injury (4), cardiac enlargement (2), conduction abnormality (2), pseudoaneurysm (1), aneurysm (1), and septal defect (1). No operative intervention was required for the complications. The 1-year and 9-year survival rates were 97% and 88%, respectively. Conclusions: Penetrating cardiac injuries remain highly lethal. A significant rate of cardiac complications can be expected and follow-up echocardiographic evaluation is warranted prior to discharge. The majority of these, however, can be managed without the need for surgical intervention.
AB - Hypothesis: A significant rate of postdischarge complications is associated with penetrating cardiac injuries. Design: Retrospective trauma registry review. Setting: Level I trauma center. Patients: All patients sustaining penetrating cardiac injuries between January 2000 and June 2010. Patient demographics, clinical data, operative findings, outpatient follow-up, echocardiogram results, and outcomes were extracted. Main Outcome Measures: Cardiac-related complications and mortality. Results: During the 10.5-year study period, 406 of 40 706 trauma admissions (1.0%) sustained penetrating cardiac injury. One hundred nine (26.9%) survived to hospital discharge. The survivors were predominantly male (94.4%), with a mean (SD) age of 30.8 (11.7) years, and 74.3% sustained a stab wound. Signs of life were present on admission in 92.6%. Cardiac chambers involved were the right ventricle (45.9%), left ventricle (40.3%), right atrium (10.1%), left atrium (0.9%), and combined (2.8%). Inhospital follow-up was available for a mean (SD) of 11.0 (9.8) days (median, 8 days; range, 3-65 days) and outpatient follow-up was available in 46 patients (42.2%) for a mean (SD) of 1.9 (4.1) months (median, 0.9 months; range, 0.2-12 months). Abnormal echocardiograms demonstrated pericardial effusions (9), abnormal wall motion (8), decreased ejection fraction (<45%) (8), intramural thrombus (4), valve injury (4), cardiac enlargement (2), conduction abnormality (2), pseudoaneurysm (1), aneurysm (1), and septal defect (1). No operative intervention was required for the complications. The 1-year and 9-year survival rates were 97% and 88%, respectively. Conclusions: Penetrating cardiac injuries remain highly lethal. A significant rate of cardiac complications can be expected and follow-up echocardiographic evaluation is warranted prior to discharge. The majority of these, however, can be managed without the need for surgical intervention.
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U2 - 10.1001/archsurg.2011.226
DO - 10.1001/archsurg.2011.226
M3 - Article
C2 - 21931004
AN - SCOPUS:80053073659
SN - 0004-0010
VL - 146
SP - 1061
EP - 1066
JO - Archives of Surgery
JF - Archives of Surgery
IS - 9
ER -