BACKGROUND We performed a systematic review (SR) and meta-analysis (MA) to determine the diagnostic accuracy of chest ultrasound (US) compared with a pericardial window (PW) for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. METHODS A literature search in five databases identified relevant articles for inclusion in this SR and MA. Studies were eligible if they evaluated the diagnostic accuracy of chest US, compared with a PW, for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients presenting with penetrating thoracic trauma. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test accuracy within the bivariate mixed-effects logistic regression modeling framework. RESULTS We included five studies in our SR and MA. These studies included a total of 556 trauma patients. The MA found that, compared with PW, the US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients. The presence of a concomitant left hemothorax was frequent in patients with false-negative results. CONCLUSION This SR and MA found that, compared with PW, US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Caution interpretation of pericardial US results is suggested in the presence of left hemothorax. In these cases, a second diagnostic test should be performed. LEVEL OF EVIDENCE Systematic Review and Meta-analysis, level II.

Introducción: La evisceración posquirúrgica es una complicación con origen multifactorial.Los estudios para prevenirla modifican la técnica de cierre. La técnica reinforced tensión line (RTL) se ha usado en el tratamiento de hernias incisionales.Material y métodos: Ensayo clínico en pacientes sometidos a laparotomía media. Se formaron dos grupos: 1) control con cierre habitual, y 2) grupo experimental con la técnica RTL. Se evaluó la presencia de evisceración posquirúrgica.Resultados: Terminaron el estudio 89 pacientes. Se presentaron un total de 9 (20 %) y 2 (4.5 %) evisceraciones, con diferencia a favor de la técnica RTL con una p de 0.0273.Conclusiones: Se encontró que la técnica RTL reduce la incidencia de evisceración posquirúrgica.

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