The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study.
BACKGROUND
Ultrasound is quickly becoming part of the trauma surgeon's practice, but its role in the patient with a penetrating truncal injury is not well defined. The purpose of this study was to evaluate the accuracy of emergency ultrasound as it was introduced into five Level I trauma centers for the diagnosis of acute hemopericardium.


METHODS
Surgeons or cardiologists (four centers) and technicians (one center) performed pericardial ultrasound examinations on patients with penetrating truncal wounds. By protocol, patients with positive examinations underwent immediate operation. Vital signs, base deficit, time from examination to operation, operative findings, treatment, and outcome were recorded.


RESULTS
Pericardial ultrasound examinations were performed in 261 patients. There were 225 (86.2%) true-negative, 29 (11.1%) true-positive, 0 false-negative, and 7 (2.7%) false-positive examinations, resulting in sensitivity of 100%, specificity of 96.9%, and accuracy of 97.3%. The mean time from ultrasound to operation was 12.1+/-5 minutes.


CONCLUSIONS
Ultrasound should be the initial modality for the evaluation of patients with penetrating precordial wounds because it is accurate and rapid.
Rozycki
G S
GS
Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Feliciano
D V
DV
Ochsner
M G
MG
Knudson
M M
MM
Hoyt
D B
DB
Davis
F
F
Hammerman
D
D
Figueredo
V
V
Harviel
J D
JD
Han
D C
DC
Schmidt
J A
JA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002648:Child; D004630:Emergencies; D005260:Female; D006335:Heart Injuries / Q000145:classification / Q000000981:diagnostic imaging*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014193:Trauma Centers; D014463:Ultrasonography; D014481:United States; D014950:Wounds, Penetrating / Q000145:classification / Q000000981:diagnostic imaging*