Screening for Occult Penetrating Cardiac Injuries

Nicol, Andrew; Navsaria, Pradeep; Beningfield, Steve; Hommes, Martijn; Kahn, Delawir

doi:10.1097/sla.0000000000000713

Cited by 39 publications

(53 citation statements)

References 36 publications

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“…Although US is advocated as an accurate and sensitive tool to detect a hemopericardium [28][29][30][31], the presence of hemothorax and/or pneumopericardium confounds the interpretation of US and may lead to a high number of false-negative investigations. In case of equivocal US results or the presence of a hemothorax, CT is the adjunctive of choice to screen for occult penetrating cardiac injuries or repeat US at 24 h once the hemothorax has cleared [32]. In only 10.4% of all patients presenting with diagnosed PTI, there was a primary indication for surgical treatment: EDT (2.4%), UTS (3.2%), and planned SXW (4.8%).…”

Section: Discussionmentioning

confidence: 96%

Selective nonoperative management of penetrating thoracic injury

Waes

Halm

Imhoff

et al. 2018

European Journal of Emergency Medicine

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PTI has a low in-hospital mortality rate. Only 16.5% (41/248) of the patients presenting with PTI will need surgical treatment. The other patients are safe to be treated conservatively according to a protocolized SNOM approach for PTI without any additional mortality. Conservative treatment of patients who were selected for this nonoperative treatment strategy with repeated clinical reassessment was successful in 93.2%.

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Section: Discussionmentioning

confidence: 96%

Selective nonoperative management of penetrating thoracic injury

Waes

Halm

Imhoff

et al. 2018

European Journal of Emergency Medicine

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“…We suggest that stable patients with penetrating thoracic injury should undergo thoracic CT. FAST/ echocardiography is operator-dependent and might miss a cardiac injury due to a pneumothorax or a lack of tamponade, when the pericardium has been decompressed by blood entering the pleural cavity [ 24 , 25 ]. Pericardial fluid or air on CT might indicate cardiac injury and the question of surgery vs conservative treatment arises.…”

Section: Discussionmentioning

confidence: 99%

Survival predictor for penetrating cardiac injury; a 10-year consecutive cohort from a scandinavian trauma center

Kaljusto

Skaga

Pillgram-Larsen

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundPenetrating cardiac injuries in Europe have been poorly studied. We present a 10-year outcome for patients with penetrating heart injuries at Oslo University Hospital.MethodsData from 01.01.2001 until 31.12.2010 was collected from the Oslo University Hospital Trauma Registry and from the patients’ records.ResultsThirty-one patients were admitted with a penetrating cardiac injury. Fourteen patients survived (45 %). Four out of 8 patients (50 %) with gunshot wounds survived compared to 10 out of 23 (44 %) with stab wounds. Median (quartiles) for the following values were: Injury Severity Score 25 (21–35), Revised Trauma Score 0 (0–6,9), Probability of Survival 0,015 (0,004–0,956), Glasgow Coma Scale 3 (3–13). Thirteen patients had signs of life on admission and survived. Eighteen patients were admitted without signs of life and received emergency department thoracotomy. Eight of these had no signs of life at the scene of injury and did not survive. Out of the remaining 10 patients, one survived.ConclusionsThe outcome of patients with penetrating cardiac injury reaching the emergency department with signs of life was excellent. Hemodynamic instability indicates immediate surgery. Stable patients with penetrating thoracic trauma and possible cardiac injury detected by imaging should be considered for conservative treatment.

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“…Difficulties in the performance and interpretation of cardiac ultrasound in penetrating trauma appear to be in patients with a co-existent hemothorax [26,28] air in the pericardial sac [29], and also lacerations of the pericardial sac [30]. This may be because the fluid accumulates into the thoracic cavity rather than the pericardium, or that it the hemothorax obscures the pericardium and makes differentiation of anatomical planes difficult.…”

Section: Discussionmentioning

confidence: 97%

“…The authors found that, if there is presence or suggestion of either hemothorax or pneumopericardium, then further diagnostic testing is required [29]. Similarly, a 2009 study, found that the numbers of false negatives were increased with concurrent lacerations of the pericardial sac secondary to sequestration of the blood into the thoracic cavity therefore preventing accumulation of a hemopericardium [30].…”

Section: Ultrasound For Penetrating Cardiac Injurymentioning

confidence: 99%

Ultrasound in the evaluation of penetrating thoraco-abdominal trauma: a review of the literature

et al. 2015

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The use of ultrasound in the evaluation of blunt thoraco-abdominal trauma is well described. Evidence for the use of ultrasound in the evaluation of penetrating cardio-thoracic and abdominal trauma, however, is more limited and varied. Current literature demonstrates that ultrasound is an excellent screening tool for penetrating thoracic and cardiac injuries with a high sensitivity for detecting injury requiring acute intervention. For abdominal injuries, however, the sensitivity for detection of injury is low and thus the utility of ultrasound as a screening tool is limited. This review summarizes the existing literature addressing the clinical utility of ultrasound for penetrating trauma to the pericardium, thorax and abdomen.

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Screening for Occult Penetrating Cardiac Injuries

Abstract: The sensitivity of US to detect hemopericardium in stable patients was only 86.7%. The 2 main factors that limit the screening are the presence of a hemothorax and air in the pericardial sac. A new regimen for screening of occult injuries to make allowance for this is proposed.

Cited by 39 publications

References 36 publications

Selective nonoperative management of penetrating thoracic injury

Selective nonoperative management of penetrating thoracic injury

Survival predictor for penetrating cardiac injury; a 10-year consecutive cohort from a scandinavian trauma center

Ultrasound in the evaluation of penetrating thoraco-abdominal trauma: a review of the literature

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