Demography of Penetrating Cardiac Trauma

Abstract

All cases of penetrating cardiac trauma in 1985 and 1986 in Jefferson County, Alabama, where patients dying of penetrating trauma received autopsies, were retrospectively reviewed. All hospitals in the county plus the single coroner's office provided the records of the 72 patients comprising this study. Incidents occurred most often in the home or residence (70%) by a known assailant (83%) due to domestic/social disputes (73%). Frequency was greatest in the evening hours (73% between 6:00 PM and 3:00 AM), on weekends in spring and summer. Victims tended to be male (86%), black (72%), married (46%), blue collar workers (62%). There were 41 (57%) gunshot wounds, 3 (4%) shotgun wounds, and 28 (39%) stab wounds with an associated mortality rate of 97%, 100%, and 68%, respectively. Prehospital mortality rate (dead at the scene) was 54.2% (39/72), and death on arrival was 26.4% (19/72), for a combined pretreatment mortality rate of 80.6%. All patients who arrived with no vital signs died. Mortality appeared to be related to mechanism of injury, age, race, sex, vital signs on arrival, number and specific cardiac chambers injured, associated major vascular injury, hematocrit, and mode of transportation. Mortality was not related to caliber of weapon, ethanol level, transport time, time from arrival to operation, or transfusion requirements. There were only ten survivors (1 gunshot wound and 9 stab wounds), all of whom had ventricular injuries and no associated major vascular injuries. The ten survivors represented a 71.4% (10/14) salvage rate for those victims arriving with vital signs. Complications occurred in three patients. Hospitalization averaged 7.3 days in the survivors. Penetrating cardiac trauma remains a serious, socially linked disease with a high rate of mortality. Rapid transport, aggressive resuscitation and cardiorrhaphy remain the best treatment.

Penetrating cardiac injuries: assessment of 21 patients

“…Hastane öncesi önlemlerin de alındığı bir çalışmada mortalite oranının helikopter ambulansı ile hastaneye getirilen hastalarda %33, ambulansla getirilen hastalarda %76, niteliksiz araçlarla getirilen hastalarda %100 bulunduğu belirtilmektedir. [7] Buckman ve arkadaşları [5] tüm ölümlerin %78'inin kardiyak yaralanmadan sonraki ilk saatte oluştuğunu bildirmektedir. Bizim çalışmamızda, anamnez bilgilerine göre hastaların hastaneye ulaşım süresi 10 ile 120 dakika arasın-da değişiyordu.…”

Fatores prognósticos de mortalidade em pacientes com trauma cardíaco que chegam à sala de cirurgia

“…Esta lesão é produzida usualmente por arma branca, uma vez que esta câmara apresenta-se na face anterior do tórax, próxima à parede, sendo suscetível aos ataques frontais com estes instrumentos que apresentam baixo poder de penetração. Esta é considerada a lesão cardíaca mais fácil de lidar, uma vez que não há comprometimento de lesão tecidual e a própria musculatura ventricular poderá tamponá-la parcialmente além do fácil acesso para o cirurgião 4,7,13,15,16,23,34,35 . As lesões atriais são consideradas de maior gravidade pelo sangramento contí-nuo que apresentam por não haver possibilidade de tamponamento pela sua fina parede.…”

Suicide by tapestry needle

“…4 Penetrating cardiac injuries caused by bullets, knives, hooks form an essential subset of traumatic cardiac diseases. 2,5 Such wounds are localized most often to the free wall of right ventricle and in decreasing order, free wall of left ventricle, right atrium and left atrium. The pathophysiological outcome depends on many factors e.g., type of penetrating tool, site of the injury, existence of pericardial trauma, involvement of lung penetration, speed of the instrument.…”