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Penetrating cardiac injuries: predictive model for outcomes based on 2016 patients from the National Trauma Data Bank

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

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References

  1. Demetriades D, Van Der Veen BW. Penetrating injuries of the heart: experience over two years in South Africa. J Trauma. 1983;23:1034–41.

    Article  CAS  Google Scholar 

  2. Abbott JA, Cousineau M, Cheitlin M, et al. Late sequelae of penetrating cardiac wounds. J Thorac Cardiovasc Surg. 1978;75:510–8.

    CAS  PubMed  Google Scholar 

  3. Attar S, Suter CM, Hankins JR, et al. Penetrating cardiac injuries. Ann Thorac Surg. 1991;51:711–6.

    Article  CAS  Google Scholar 

  4. Beall AC Jr, Patrick TA, Ikles JE, et al. Penetrating wounds of the heart: changing patterns of surgical management. J Trauma. 1972;12:468–73.

    Article  Google Scholar 

  5. Beach PM Jr, Bognolo D, Hutchinson JE. Penetrating cardiac trauma, experience with thirty-four patients in a hospital without cardiopulmonary bypass capability. Am J Surg. 1976;131:411–4.

    Article  Google Scholar 

  6. Breaux EP, Dupont JB Jr, Albert HM, et al. Cardiac tamponade following penetrating mediastinal injuries: improved survival with early pericardiocentesis. J Trauma. 1979;19:461–6.

    Article  CAS  Google Scholar 

  7. Carrasquilla C, Wilson RF, Walt AJ, et al. Gunshot wounds of the heart. Ann Thorac Surg. 1972;13:208–13.

    Article  CAS  Google Scholar 

  8. Degennaro VA, Bonfils-Roberts EA, Ching N, et al. Aggressive management of potential penetrating cardiac injuries. J Thorac Cardiovasc Surg. 1980;79:833–7.

    CAS  PubMed  Google Scholar 

  9. Demetriades D. Cardiac penetrating injuries: personal experience of 45 cases. Br J Surg. 1984;71:95–7.

    Article  CAS  Google Scholar 

  10. Evans J, Gray LA Jr, Payner A, et al. Principles for the management of penetrating cardiac wounds. Ann Surg. 1979;189:777–84.

    Article  CAS  Google Scholar 

  11. Feliciano DV, Bitondo CG, Mattox KL, et al. Civilian trauma in the 1980s. A one year experience with 456 vascular and cardiac injuries. Ann Surg. 1980;1984(199):717–24.

    Google Scholar 

  12. Harvey JC, Pacifico AD. Primary operative management: method of choice for stab wounds to the heart. South Med J. 1975;68:149–52.

    Article  CAS  Google Scholar 

  13. Ivatury RR, Rohman M, Steichen FM, et al. Penetrating cardiac injuries: twenty-year experience. Ann Surg. 1987;53:310–7.

    CAS  Google Scholar 

  14. Mandal AK, Awariefe SO, Oparah SS. Experience in the management of 50 consecutive penetrating wounds of the heart. Br J Surg. 1979;66:565–8.

    Article  CAS  Google Scholar 

  15. Mandal AK, Oparah SS. Unusually low mortality of penetrating wounds of the chest: twelve years’ experience. J Thorac Cardiovasc Surg. 1989;97:119–25.

    CAS  PubMed  Google Scholar 

  16. Moreno C, Moore EE, Majure JA, et al. Pericardial tamponade: a critical determinant for survival following penetrating cardiac wounds. J Trauma. 1986;26:821–5.

    Article  CAS  Google Scholar 

  17. Naughton MJ, Brissle RM, Bessey PQ, et al. Demography of penetrating cardiac trauma. Ann Surg. 1989;209:676–83.

    Article  CAS  Google Scholar 

  18. Sugg WL, Rea WJ, Ecker RR, et al. Penetrating wounds of the heart: analysis of 459 cases. J Thorac Cardiovasc Surg. 1968;56:531–45.

    CAS  PubMed  Google Scholar 

  19. Symbas PN, Harlaftis N, Waldo WJ. Penetrating cardiac wounds: a comparison of different therapeutic methods. Ann Surg. 1976;183:377–81.

    Article  CAS  Google Scholar 

  20. Tavares S, Hankins JR, Moulton AL, et al. Management of penetrating cardiac injuries: the role of emergency thoracotomy. Ann Thorac Surg. 1984;38:183–7.

    Article  CAS  Google Scholar 

  21. Blake DP, Gisbert VL, Ney AL, et al. Survival after emergency department versus operating room thoracotomy for penetrating cardiac injuries. Am Surg. 1992;58:329–33.

    CAS  PubMed  Google Scholar 

  22. Buchman TG, Phillips J, Menker JB. Recognition, resuscitation and management of patients with penetrating cardiac injuries. SGO. 1992;174:205–10.

    CAS  PubMed  Google Scholar 

  23. Mitchell ME, Muakkassa FF, Poole GV, et al. Surgical approach of choice for penetrating cardiac wounds. J Trauma. 1993;34:17–20.

    Article  CAS  Google Scholar 

  24. Macho JR, Markison RE, Schecter WP. Cardiac stapling in the management of penetrating injuries of the heart: rapid control of hemorrhage and decreased risk of personal contamination. J Trauma. 1993;34:711–6.

    Article  CAS  Google Scholar 

  25. Roberge RR, Ivatury RR, Stahl W, et al. Emergency department thoracotomy for penetrating injuries: predictive value of patient classification. Am J Emerg Med. 1986;4:129–35.

    Article  CAS  Google Scholar 

  26. Knott-Craig CJ, Dalton RP, Rossouw GJ, et al. Penetrating cardiac trauma: management strategy based on 129 surgical emergencies over 2 years. Ann Thorac Surg. 1992;53:1006–9.

    Article  CAS  Google Scholar 

  27. Steichen FM, Dargan EL, Efron G, et al. A graded approach to the management of penetrating wounds of the heart. Arch Surg. 1971;103:574–80.

    Article  CAS  Google Scholar 

  28. Brown SE, Gomez GA, Jacobson LE, et al. Penetrating chest trauma: should indications for emergency room thoracotomy be limited? Am Surg. 1996;62:530–4.

    CAS  PubMed  Google Scholar 

  29. Hirshberg A, Wall MJ, Allen MK, et al. Double jeopardy: thoracoabdominal injuries requiring surgical intervention in both chest and abdomen. J Trauma. 1995;39:225–31.

    Article  CAS  Google Scholar 

  30. Mazzorana V, Smith RS, Morabito DJ, et al. Limited utility of emergency department thoracotomy. Am Surg. 1994;60:516–21.

    CAS  PubMed  Google Scholar 

  31. Saadia R, Levy RD, Degiannis E, et al. Penetrating cardiac injuries: clinical classification and management strategy. Br J Surg. 1994;81:1572–5.

    Article  CAS  Google Scholar 

  32. Kaplan AJ, Norcross ED, Crawford FA. Predictors of mortality in penetrating cardiac injury. Am Surg. 1993;59:338–41.

    CAS  PubMed  Google Scholar 

  33. Buckman RF, Badellino MM, Mauro LH, Asensio JA, et al. Penetrating cardiac wounds: prospective study of factors influencing initial resuscitation. J Trauma. 1993;34:717–27.

    Article  Google Scholar 

  34. Asensio JA, Murray J, Demetriades D, et al. Penetrating cardiac injuries: a prospective study of variables predicting outcomes. J Am Coll Surg. 1998;186:24–34.

    Article  CAS  Google Scholar 

  35. Asensio JA, Berne JD, Demetriades D, Chan L, Murray J, Falabella A, et al. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998;44(6):1073–82.

    Article  CAS  Google Scholar 

  36. Gao JM, Gao YH, Wei GB, Liu GL, Tian XY, Hu P, Li CH. Penetrating cardiac wounds: principles for surgical management. World J Surg. 2004;28(10):1025–9 (Epub 2004 Sep 29).

    Article  Google Scholar 

  37. Rodrigues AJ, Lopes-Furlanetti LL, Bijos-Faidiga G, Scarpelivi S, et al. Penetrating cardiac injuries: a 13 year retrospective evaluation form a Brazilian trauma center. Interact Cardiovasc Thorac Surg. 2005;4:p212–5.

    Article  Google Scholar 

  38. Topal AE, Celik Y, Eren MN. Predictors of outcome in penetrating cardiac injuries. J Trauma. 2010;69(3):574–8.

    Article  Google Scholar 

  39. Murry JS, Truitt MS, Dunn EL. Penetrating cardiac injuries at a level II trauma center: a 15-year review. Am Surg. 2015;81(3):324–5.

    PubMed  Google Scholar 

  40. Asensio JA, Stewart BM, Murray J, et al. Penetrating cardiac injuries. Surg Clin North Am. 1996;76:685–724.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA

    J. A. Asensio, O. A. Ogun, M. Wagner, R. Bertellotti, B. Phillips, D. L. Cornell & A. O. Udekwu

  2. Department of Surgery, New York Medical College, Valhalla, New York, USA

    P. Petrone

  3. Department of Surgery, University of Granada, Granada, Andalucia, Spain

    A. J. Perez-Alonso

  4. Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA

    J. A. Asensio

Authors
  1. J. A. Asensio
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  2. O. A. Ogun
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  3. P. Petrone
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  4. A. J. Perez-Alonso
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  5. M. Wagner
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  6. R. Bertellotti
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  7. B. Phillips
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  8. D. L. Cornell
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  9. A. O. Udekwu
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Contributions

Study conception and design: JAA. Acquisition of data: PP. Analysis and interpretation of data: JA, PP. Drafting of manuscript: AO. Critical revision: JA, AO, AOU, MW, RB, BP, DLC.

Corresponding author

Correspondence to J. A. Asensio.

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Conflict of interest

J. A. Asensio, O. A. Ogun, P. Petrone, A.J. Perez-Alonso, M. Wagner MD, R. Bertellotti, B. Phillips, D. L. Cornell, and A. O. Udekwu, all declare that they have no conflicts of interest.

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Asensio, J.A., Ogun, O.A., Petrone, P. et al. Penetrating cardiac injuries: predictive model for outcomes based on 2016 patients from the National Trauma Data Bank. Eur J Trauma Emerg Surg 44, 835–841 (2018). https://doi.org/10.1007/s00068-017-0806-6

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  • DOI: https://doi.org/10.1007/s00068-017-0806-6

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