McNicoll Christopher F, McNickle Allison G, Vanderet Danielle, Patel Purvi P, Souchon Patricia, Kuhls Deborah A, Fraser Douglas R, Chestovich Paul J
Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States.
Department of Surgery, Division of Acute Care Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, 1701 West Charleston Blvd., Suite 490, Las Vegas, NV, 89102, United States.
Injury. 2023 May;54(5):1349-1355. doi: 10.1016/j.injury.2023.01.046. Epub 2023 Jan 26.
Penetrating cardiac injuries (PCI) are often fatal despite rapid transport and treatment in the prehospital setting. Although many studies have identified risk factors for mortality, few studies have included non-transported field mortalities. This study analyzes penetrating cardiac injuries including hospital and coroner reports in the current era.
Seventeen years of data were reviewed, including the trauma center (TC) registry, medical records, and coroner reports from 2000-2016. PCI were graded using American Association for the Surgery of Trauma (AAST) cardiac organ injury score (COIS). Subjects were divided into three groups: field deaths, hospital deaths, and survivors to hospital discharge. The primary outcome is survival to hospital discharge overall and among those transported to the hospital.
During the study period, 643 PCI patients were identified, with 52 excluded for inadequate data, leaving 591 for analysis. Mean age was 38.1 ± 17.5 years, and survivors (n=66) were significantly younger than field deaths (n=359) (32.6 ± 14.4 vs 41.1 ± 18.5, p<0.001). Stab wounds had higher survival than gunshot wounds (26.6% vs. 4.3%, p<0.001). COIS grades 4 to 6 (n=602) had lower survival than grades 1 to 3 (n=41) (8.3% vs. 39.0%, p<0.001). Survivors (n=66) had lower median COIS than patients who died in hospital (n=218) (4 vs. 5, p<0.001). Single chamber PCI had higher survival than multiple chamber PCI (13% vs. 5%, p=0.004). The left ventricle is the most injured (n=177), and right ventricle PCI has the highest survival (p<0.001). Of field deaths, left ventricular injuries had the highest single chamber mortality (60%), equaling multi-chamber PCI (60%).
Survival to both TC evaluation and hospital discharge following PCI is influenced by many factors including age, mechanism, anatomic site, and grade. Despite advances in trauma care, survival has not appreciably improved.
尽管在院前环境中能迅速转运并接受治疗，但穿透性心脏损伤（PCI）往往是致命的。虽然许多研究已确定了死亡风险因素，但很少有研究纳入未转运至医院的现场死亡病例。本研究分析了当代包括医院报告和验尸官报告在内的穿透性心脏损伤情况。
回顾了17年的数据，包括创伤中心（TC）登记册、病历以及2000年至2016年的验尸官报告。使用美国创伤外科协会（AAST）心脏器官损伤评分（COIS）对PCI进行分级。研究对象分为三组：现场死亡、医院死亡和存活至出院。主要结局是总体存活至出院以及转运至医院的患者的存活情况。
在研究期间，共识别出643例PCI患者，其中52例因数据不足被排除，剩余591例用于分析。平均年龄为38.1±17.5岁，存活者（n = 66）明显比现场死亡者（n = 359）年轻（32.6±14.4岁 vs 41.1±18.5岁，p<0.001）。刺伤的存活率高于枪伤（26.6%对4.3%，p<0.001）。COIS 4至6级（n = 602）的存活率低于1至3级（n = 41）（8.3%对39.0%，p<0.001）。存活者（n = 66）的COIS中位数低于在医院死亡的患者（n = 218）（4对5，p<0.001）。单腔PCI的存活率高于多腔PCI（13%对5%，p = 0.004）。左心室是最常受伤的部位（n = 177），右心室PCI的存活率最高（p<0.001）。在现场死亡病例中，左心室损伤的单腔死亡率最高（60%），与多腔PCI相同（60%）。
PCI后存活至TC评估及出院受多种因素影响，包括年龄、致伤机制、解剖部位和损伤分级。尽管创伤护理有所进展，但存活率并未明显提高。
