Successful diagnosis of penetrating cardiac injury using surgeon-performed sonography.

BACKGROUND

Patients with penetrating cardiac injuries have a high mortality. The utilization of sonography in these patients may lead to earlier diagnosis and definitive surgical intervention.

METHODS

A retrospective review of all patients admitted to a level I trauma center were examined from March 1996 to March 2001 (17,241 patients). Patients were identified with penetrating thoracic injuries and were evaluated for mechanism of injury, sonographic findings (subxiphoid and parasternal windows), injury severity score, length of stay, and mortality. Surgeons performed all sonography.

RESULTS

There were 478 patients who underwent sonography for penetrating thoracic injuries. Twenty-three patients were identified with positive sonographic findings. Subsequently 20 patients had a cardiac injury at surgery. There were no missed injuries. The 3 patients with false positive findings had congestive heart failure (2 patients) and morbid obesity (1 patient). Mean time to operation was 13 minutes. Mean injury severity score was 33. Mean intensive care unit and hospital stay was 3.1 days and 7.2 days respectively. Sonography had a specificity of 99.3% and sensitivity of 100% for identifying penetrating cardiac injury and a positive predictive value of 87% and negative predictive value of 100%. There were no hospital deaths.

CONCLUSIONS

Early diagnosis and management using surgeon performed sonography may reduce the high mortality associated with penetrating cardiac injury.