Penetrating Cardiac Injuries: Predictive Model for Outcomes Based on 2016 Patients from the National Trauma Data Bank

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2017 Jun 5

PMID 28578468

Citations 8

Authors

J A Asensio

O A Ogun

P Petrone

A J Perez-Alonso

M Wagner

R Bertellotti

B Phillips

D L Cornell

A O Udekwu

Affiliations

Soon will be listed here.

Abstract

Background: Penetrating cardiac injuries are uncommon and lethal. The objectives of this study are to examine the national profile of cardiac injuries, identify independent predictors of outcome, generate, compare and validate previous predictive models for outcomes. We hypothesized that National Trauma Data Bank (NTDB) given its large number of patients, would validate these models.

Methods: The NTDB was queried for data on cardiac injuries, using survival as the main outcome measure. Statistical analysis was performed utilizing univariate and stepwise logistic regression. The stepwise logistic regression model was then compared with other predictive models of outcome.

Results: There were 2016 patients with penetrating cardiac injuries identified from 1,310,720 patients. Incidence: 0.16%. Mechanism of injury: GSWs-1264 (63%), SWs-716 (36%), Shotgun/impalement-19/16 (1%). Mean RTS 1.75, mean ISS 27 ± 23. Overall survival 675 (33%). 830 patients (41%) underwent ED thoracotomy, 47 survived (6%). Survival stratified by mechanism: GSWs 114/1264 (10%), SWs 564/717 (76%). Predictors of outcome for mortality-univariate analysis: vital signs, RTS, ISS, GCS: Field CPR, ED intubation, ED thoracotomy and aortic cross-clamping (p < 0.001). Stepwise logistic regression identified cardiac GSW's (p < 0.001; AOR 26.85; 95% CI 17.21-41.89), field CPR (p = 0.003; AOR 3.65; 95% CI 1.53-8.69), the absence of spontaneous ventilation (p = 0.008; AOR 1.08, 95% CI 1.02-1.14), the presence of an associated abdominal GSW (p = 0.009; AOR 2.58, 95% CI 1.26-5.26) need for ED airway (p = 0.0003 AOR 1386.30; 95% CI 126.0-15251.71) and aortic cross-clamping (p = 0.0003 AOR 0.18; 95% CI 0.11-0.28) as independent predictors for mortality. Overall predictive power of model-93%.

Conclusion: Predictors of outcome were identified. Overall survival rates are lower than prospective studies report. Predictive model from NTDB generated larger number of strong independent predictors of outcomes, correlated and validated previous predictive models.

Citing Articles

Serum lactate level is an independent predictor of mortality in cardiac stab wounds - A South African experience.

Kong V, Ko J, Narayanan A, Hassan S, Leow P, Lim J Surg Pract Sci. 2025; 12():100157.

PMID: 39845296 PMC: 11750025. DOI: 10.1016/j.sipas.2023.100157.

Penetrating right ventricular injury following a single gunshot to the left flank in Iraq: a case report.

Majeed Z, Othman Y, Ali R J Trauma Inj. 2024; 36(3):253-257.

PMID: 39381694 PMC: 11309277. DOI: 10.20408/jti.2022.0073.

Resuscitation and Forensic Factors Influencing Outcome in Penetrating Cardiac Injury.

Aumaitre A, Delteil C, Tuchtan L, Piercecchi-Marti M, Gainnier M, Carvelli J Diagnostics (Basel). 2024; 14(13).

PMID: 39001296 PMC: 11241016. DOI: 10.3390/diagnostics14131406.

Trends of Hospitalizations and In-Hospital Outcomes for Traumatic Cardiac Injury in United States.

Mehta H, Gheith Z, Amin S, Acharya P, Daon E, Downey P Kans J Med. 2024; 17:45-50.

PMID: 38859990 PMC: 11164420. DOI: 10.17161/kjm.vol17.21442.

Unveiling an Asymptomatic Cardiac Air-Gunshot Injury.

Bardeesi A, Koussa M, Vincentelli A, Coisne A, Montaigne D, Pontana F JACC Case Rep. 2024; 29(10):102319.

PMID: 38633863 PMC: 11022093. DOI: 10.1016/j.jaccas.2024.102319.

References

Beall Jr A, Patrick T, Okies J, Bricker D, DEBAKEY M . Penetrating wounds of the heart: changing patterns of surgical management. J Trauma. 1972; 12(6):468-73. DOI: 10.1097/00005373-197206000-00003. View

Evans J, GRAY Jr L, Rayner A, Fulton R . Principles for the management of penetrating cardiac wounds. Ann Surg. 1979; 189(6):777-84. PMC: 1397211. DOI: 10.1097/00000658-197906000-00015. View

Mitchell M, Muakkassa F, Poole G, Rhodes R, Griswold J . Surgical approach of choice for penetrating cardiac wounds. J Trauma. 1993; 34(1):17-20. DOI: 10.1097/00005373-199301000-00003. View

Brown S, Gomez G, JACOBSON L, Scherer 3rd T, McMillan R . Penetrating chest trauma: should indications for emergency room thoracotomy be limited?. Am Surg. 1996; 62(7):530-3; discussion 533-4. View

Symbas P, Harlaftis N, Waldo W . Penetrating cardiac wounds: A comparison of different therapeutic methods. Ann Surg. 1976; 183(4):377-81. PMC: 1344207. DOI: 10.1097/00000658-197604000-00008. View

Saadia R, Levy R, Degiannis E, Velmahos G . Penetrating cardiac injuries: clinical classification and management strategy. Br J Surg. 1994; 81(11):1572-5. DOI: 10.1002/bjs.1800811106. View

SUGG W, REA W, Ecker R, Webb W, ROSE E, SHAW R . Penetrating wounds of the heart. An analysis of 459 cases. J Thorac Cardiovasc Surg. 1968; 56(4):531-45. View

Asensio J, Stewart B, Murray J, Fox A, Falabella A, Gomez H . Penetrating cardiac injuries. Surg Clin North Am. 1996; 76(4):685-724. DOI: 10.1016/s0039-6109(05)70476-x. View

Degennaro V, Ching N, NEALON Jr T . Aggressive management of potential penetrating cardiac injuries. J Thorac Cardiovasc Surg. 1980; 79(6):833-7. View

10.

Topal A, Celik Y, Eren M . Predictors of outcome in penetrating cardiac injuries. J Trauma. 2010; 69(3):574-8. DOI: 10.1097/TA.0b013e3181bc783a. View

11.

Asensio J, Berne J, Demetriades D, Chan L, Murray J, Falabella A . One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998; 44(6):1073-82. DOI: 10.1097/00005373-199806000-00022. View

12.

Kaplan A, Norcross E, Crawford F . Predictors of mortality in penetrating cardiac injury. Am Surg. 1993; 59(6):338-41. View

13.

Mazzorana V, Smith R, Morabito D, Brar H . Limited utility of emergency department thoracotomy. Am Surg. 1994; 60(7):516-20; discussion 520-1. View

14.

Mandal A, Oparah S . Unusually low mortality of penetrating wounds of the chest. Twelve years' experience. J Thorac Cardiovasc Surg. 1989; 97(1):119-25. View

15.

STEICHEN F, DARGAN E, EFRON G, PEARLMAN D, WEIL P . A graded approach to the management of penetrating wounds of the heart. Arch Surg. 1971; 103(5):574-80. DOI: 10.1001/archsurg.1971.01350110072011. View

16.

Rodrigues A, Furlanetti L, Faidiga G, Scarpelini S, Evora P, Vicente W . Penetrating cardiac injuries: a 13-year retrospective evaluation from a Brazilian trauma center. Interact Cardiovasc Thorac Surg. 2007; 4(3):212-5. DOI: 10.1510/icvts.2004.099952. View

17.

Roberge R, Ivatury R, Stahl W, ROHMAN M . Emergency department thoracotomy for penetrating injuries: predictive value of patient classification. Am J Emerg Med. 1986; 4(2):129-35. DOI: 10.1016/0735-6757(86)90157-9. View

18.

Blake D, Gisbert V, Ney A, Helseth H, Plummer D, Ruiz E . Survival after emergency department versus operating room thoracotomy for penetrating cardiac injuries. Am Surg. 1992; 58(6):329-32; discussion 332-3. View

19.

Harvey J, PACIFICO A . Primary operative management: method of choice for stab wounds to the heart. South Med J. 1975; 68(2):149-52. View

20.

Mandal A, Awariefe S, Oparah S . Experience in the management of 50 consecutive penetrating wounds of the heart. Br J Surg. 1979; 66(8):565-8. DOI: 10.1002/bjs.1800660814. View