title: Blunt cardiac rupture: a 5-year NTDB analysis.
abstract: OBJECTIVE
  Because of its rarity and high rate of mortality, traumatic blunt cardiac rupture (BCR) has been poorly studied. The objective of this study was to use the National Trauma Data Bank to review the epidemiology and outcomes associated with traumatic BCR.
  
  
  METHODS
  After approved by the institutional review board, the National Trauma Data Bank (version 5.0) was queried for all BCR occurring between 2000 and 2005. Demographics, clinical injury data, interventions, and outcomes were abstracted for each patient. Statistical analysis was performed using an unpaired Student's t test or Mann-Whitney U test to compare means and chi analysis to compare proportions. Stepwise logistic regression analysis was performed to identify independent predictors of inhospital mortality.
  
  
  RESULTS
  Of 811,531 blunt trauma patients, 366 (0.045%) had a BCR of which 334 were available for analysis, with the mean age of 45 years, 65% were men, and their mean Injury Severity Score was 58 +/- 19. The most common mechanism of injury was motor vehicle collision (73%), followed by pedestrian struck by auto (16%), and falls from height (8%). Twenty-one patients (6%) died on arrival and 140 (42%) died in the emergency room. The overall mortality for patients arriving alive to hospital was 89%. Of the patients surviving to operation, 42% survived >24 hours of which 87% were discharged. Survivors were significantly younger (39 vs. 46 years, p = 0.04), had a lower Injury Severity Score (47 vs. 56, p = 0.02), higher Glasgow Coma Scale (10 vs. 6, p < 0.001), and were more likely to present with an systolic blood pressure >or=90 mm Hg (p = 0.01). Nevertheless, none of these factors was found to be an independent risk factor for mortality.
  
  
  CONCLUSIONS
  BCR is an exceedingly rare injury, occurring in 1 of 2400 blunt trauma patients. In patients arriving alive to hospital, traumatic BCR is associated with a high mortality rate, however, is not uniformly fatal.
authors.affiliation: Division of Trauma, Los Angeles County, University of Southern California Medical Center, Los Angeles, California 90033-4525, USA.
authors.forename: Pedro G R
authors.initials: PG
authors.lastname: Teixeira
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Didem
authors.initials: D
authors.lastname: Oncel
authors.forename: Joseph
authors.initials: J
authors.lastname: DuBose
authors.forename: Linda
authors.initials: L
authors.lastname: Chan
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Timothy
authors.initials: T
authors.lastname: Browder
authors.forename: Carlos
authors.initials: C
authors.lastname: Brown
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006341:Heart Rupture / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*