title: Postdischarge complications after penetrating cardiac injury: a survivable injury with a high postdischarge complication rate.
abstract: OBJECTIVE
  A significant rate of postdischarge complications is associated with penetrating cardiac injuries.
  
  
  METHODS
  Retrospective trauma registry review.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  All patients sustaining penetrating cardiac injuries between January 2000 and June 2010. Patient demographics, clinical data, operative findings, outpatient follow-up, echocardiogram results, and outcomes were extracted.
  
  
  METHODS
  Cardiac-related complications and mortality.
  
  
  RESULTS
  During the 10.5-year study period, 406 of 40,706 trauma admissions (1.0%) sustained penetrating cardiac injury. One hundred nine (26.9%) survived to hospital discharge. The survivors were predominantly male (94.4%), with a mean (SD) age of 30.8 (11.7) years, and 74.3% sustained a stab wound. Signs of life were present on admission in 92.6%. Cardiac chambers involved were the right ventricle (45.9%), left ventricle (40.3%), right atrium (10.1%), left atrium (0.9%), and combined (2.8%). In-hospital follow-up was available for a mean (SD) of 11.0 (9.8) days (median, 8 days; range, 3-65 days) and outpatient follow-up was available in 46 patients (42.2%) for a mean (SD) of 1.9 (4.1) months (median, 0.9 months; range, 0.2-12 months). Abnormal echocardiograms demonstrated pericardial effusions (9), abnormal wall motion (8), decreased ejection fraction (<45%) (8), intramural thrombus (4), valve injury (4), cardiac enlargement (2), conduction abnormality (2), pseudoaneurysm (1), aneurysm (1), and septal defect (1). No operative intervention was required for the complications. The 1-year and 9-year survival rates were 97% and 88%, respectively.
  
  
  CONCLUSIONS
  Penetrating cardiac injuries remain highly lethal. A significant rate of cardiac complications can be expected and follow-up echocardiographic evaluation is warranted prior to discharge. The majority of these, however, can be managed without the need for surgical intervention.
authors.affiliation: Division of Trauma, Critical Care, and Emergency Surgery, University of Arizona, Tucson, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Tang
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Bernardino C
authors.initials: BC
authors.lastname: Branco
authors.forename: Matthew
authors.initials: M
authors.lastname: Oliver
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Joseph
authors.initials: J
authors.lastname: Herrold
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D005260:Female; D006325:Heart Atria / Q000293:injuries; D006335:Heart Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D006352:Heart Ventricles / Q000293:injuries; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010351:Patient Discharge; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D014463:Ultrasonography; D014950:Wounds, Penetrating; D055815:Young Adult