Document Detail

Factors affecting prognosis with penetrating wounds of the heart.
MedLine Citation:
PMID:  10780588     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine factors affecting prognosis for patients with penetrating wounds of the heart. METHODS: A retrospective review of 302 patients with penetrating heart wounds undergoing emergency thoracotomy (August of 1980 through June of 1997) in a Level I trauma center. RESULTS: There were 148 patients with gunshot wounds (GSW) and 154 patients with stab wounds with 23% and 58% survival rates, respectively. Of 43 patients having no signs of life at the scene, 5 patients (12%) achieved some cardiac activity and were brought to the operating room (OR), but none survived. Of 67 patients "arresting" in the ambulance, 23 got to the OR, but only 3 patients (4%) survived. Of 27 patients "arresting" in the emergency department (ED), 18 patients reached the OR, but only 5 patients (19%) survived. Of 15 patients having an ED thoracotomy because of rapid deterioration there, 4 patients (27%) survived. Thus, of the 152 patients with an ED thoracotomy, 93 patients had gunshot wounds and none survived; of the 59 with stab wounds, 12 (20%) survived (p < 0.001). Of 150 patients having an OR thoracotomy, 111 (74%) survived. Single-chamber injuries had a survival rate of 51% (112 of 219 patients), but multiple chamber and/or intrapericardial great vessel injuries had only a 13% survival rate (11 of 83 patients) (p < 0.001). Intrapericardial aortic injuries were uniformly fatal in 15 patients. In patients with stab wounds, pericardial tamponade was associated with a higher survival rate (66%; 56 of 84 patients) than in those without tamponade (47%; 33 of 70 patients). CONCLUSION: The physiologic status of the patient at presentation, mechanism of injury, and presence of a tamponade were significant prognostic factors in this series of penetrating cardiac injuries. Multiple-chamber injuries, especially with great vessel involvement, were associated with a high mortality rate. ED thoracotomies for gunshot wounds of the heart were uniformly fatal.
J G Tyburski; L Astra; R F Wilson; C Dente; C Steffes
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  48     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2000 Apr 
Date Detail:
Created Date:  2000-05-19     Completed Date:  2000-05-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  587-90; discussion 590-1     Citation Subset:  AIM; IM    
Wayne State University School of Medicine and Detroit Receiving Hospital, Michigan 48201, USA.
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MeSH Terms
Aorta / injuries
Cardiac Tamponade / complications
Heart Injuries / mortality*,  surgery
Multivariate Analysis
Retrospective Studies
Survival Rate
Wounds, Gunshot / mortality,  surgery
Wounds, Penetrating / mortality*,  surgery
Wounds, Stab / mortality,  surgery

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