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Abstract
We critically evaluated several diagnostic modalities (clinical criteria, subxiphoid
pericardial window (SPW) and laparoscopy) used in the detection of occult cardiac
injury in haemodynamically stable patients at high risk of cardiac injury. Over 5
years, 122 patients were admitted to a Level I trauma centre with such an injury.
They sustained 69 stab wounds, and 53 gunshot wounds. Sites of penetration were: precordial
(81), right chest (25), lateral chest (13), thoracoabdominal (40) and abdominal (19).
Vital signs in the emergency room were (mean ± SD): systolic BP, 111 ± 23.2 mmHg;
HR, 106 ± 18.7; GCS, 13.6 ± 1.3; and CVP, 17 ± 7.8 cmH2O. SPW was performed in all patients and was positive for haemopericardium in 26 patients,
24 (92 per cent) of whom had a cardiac injury at operation. Two patients had pericardial
lacerations without cardiac injury. In addition, 14 patients with lower precordial
and thoracoabdominal wounds underwent laparoscopy. At laparoscopy, the pericardium
was evaluated by transdiaphragmatic inspection in 10 patients. The presence (two)
or absence (eight) of blood within the pericardium was accurately predicted and verified
by SPW. Univariate and multiple logistic regression analysis of clinical data failed
to reveal any significant predictor of cardiac injury. SPW remains the standard means
of diagnosing occult cardiac injury in high-risk patients. Since the incidence of
occult cardiac injury in haemodynamically stable patients is 20 per cent, SPW should
be used liberally. Laparoscopy may have a role in evaluating the pericardium in the
subgroup of patients with lower chest wounds, and it facilitates inspection of intra-abdominal
viscera and diaphragm at the same time.
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Article info
Publication history
Accepted:
February 7,
1995
Footnotes
☆This paper was presented at the Seventh Annual EAST meeting in the Bahamas, 1994.
Identification
Copyright
© 1995 Published by Elsevier Inc.
