BackgroundTrauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management.MethodsThis is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed.ResultsThe study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120).ConclusionsThe study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach.
RESUMENAntecedentes: La mayoría de las series de pacientes con heridas de corazón publicadas en la literatura son exclusivamente descriptivas y no sufi cientemente grandes para obtener conclusiones estadísticas. La prevalencia de agresiones en la población civil de algunos sectores de las ciudades Colombianas es elevada.Materiales y métodos: Para estudiar la probabilidad de mortalidad en los pacientes que ingresan a salas de cirugía con heridas de corazón se realiza un estudio de casos y controles anidado en la cohorte histórica de 240 pacientes admitidos a salas de cirugía del Hospital Occidente de Kennedy con diagnóstico de herida penetrante de corazón, Entre enero de 1999 y Octubre de 2009. Resultados:La mortalidad global fue de 15% (n = 36): 52.9% (9/17) para los pacientes con herida por arma de fuego y 12.1% (27/223) para los pacientes con herida por arma cortopunzante. Los valores del OR permitieron establecer que las lesiones con arma de fuego, el estado hemodinámico, el grado de la herida, las lesiones concomitantes en tórax y/o abdomen y el requerimiento de una toracotomía resucitativa se asocian con mayor probabilidad de muerte. Los resultados del análisis multivariado muestran que los únicos factores que de forma conjunta se asocian con la mortalidad son la lesión con arma de fuego (OR 22.7; IC 95% 4.6-112.9), y el estado hemodinámico (fatal: OR 11.4; IC 95% 1.6-82.0, agónico: 12.8; IC 3.4-48.5, shock profundo: 10.35; IC 2.9-36.4). Conclusiones:El trauma cardiaco penetrante en nuestra serie fue causado principalmente por heridas de arma cortopunzante, con una sobrevida similar a otros estudios con este mecanismo predominante. Nuestros resultados están de acuerdo con los parámetros de riesgo de mortalidad previamente propuestos en la literatura y en nuestros pacientes el compromiso del estado hemodinámico al ingreso a cirugia y las lesiones ocasionadas por arma de fuego, demostraron ser predictores signifi cativos de la mortalidad. La presencia de taponamiento cardiaco no tuvo un efecto protector.Palabras clave: Trauma cardíaco penetrante, Arma cortopunzante, Trauma en Colombia. ABSTRACTBackground: Most studies reported in literature of patients with heart injuries are merely descriptive and not large enough to obtain statistical conclusions. The prevalence of attacks on civilians in some sectors of Colombian cities is high.
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