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

Abstract

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.

Traumatic cardiac injury: Experience from a level-1 trauma centre

“…We observed that most frequently injured cardiac chamber was right ventricle followed by right atrium and left ventricle respectively. These findings are in accordance with the published literature 25, 26…”

Our Surgical Management Strategy for Cardiac Injury

“…The overall mortality rate of patients who underwent surgery because of penetrating and blunt cardiac injury was 40.54%. On comparing with other studies, the overall mortality rate was 55% in a study conducted by Kaljusto et al and was 27.3% in a study conducted by Aksoyek et al (12,13) . Vital signs on admission can change from cardiac arrest to a completely stable status (14) .…”

“…It also enables in achieving access to all regions of the heart, including the right heart and both the pleuras (3,21) . Kaplan et al used median sternotomy as an initial incision in 28.57% of patients and Kaljusto et al used it in 35% of patients (10,13) . Aksoyek et al have preferred median sternotomy in all patients except one patient (12) .…”

“…Today, improvements in early diagnosis and aggressive surgical approach have reduced the mortality rates. Approximately 30% of patients with penetrating cardiac trauma can reach the hospital alive, and the mortality rate of these patients is approximately 50% (13) . With respect to the multidisciplinary approach, prior experience of the team surgical team and necessary medical treatment of the patient are the factors that affect mortality.…”

Re: Etikk og estetikk ved prehospital torakotomi

“…5/2017 omtales økende antibiotikaresistens (1) og bruk av bredspektret antibiotika ved urinveisinfeksjoner på sykehjem (2) med budskap om å følge de nasjonale retningslinjene for antibiotika bruk i primaerhelsetjenesten (3). Vi har nylig publisert en evaluering av urindyrkningssvar og empirisk behandling hos 161 ikke-gravide kvinner med mistenkt akutt cystitt i en solopraksis (4). Vi fant signifikant oppvekst hos 62 % av 126 pasienter som startet antibiotikabehandling.…”