Does hemopericardium after chest trauma mandate sternotomy?
BACKGROUND
Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether these were rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy.


METHODS
Records were retrospectively reviewed for all patients at a Level I trauma center (December 1996 to November 2011) who sustained chest trauma with pericardial window (PCW, n = 377) and/or median sternotomy (n = 110).


RESULTS
Fifty-five (15%) patients with positive PCW proceeded to sternotomy. Penetrating injury was the dominant mechanism (n = 49, 89%). Nineteen (35%) were hypotensive on arrival or during initial resuscitation. Most received surgeon-performed focused cardiac ultrasound examinations (n = 43, 78%) with positive results (n = 25, 58%). Ventricular injuries were most common, with equivalent numbers occurring on the right (n = 16, 29%) and left (n = 15, 27%). Six (11%) with positive PCW had isolated pericardial lacerations, but 21 (38%) had no repairable cardiac or great vessel injury. Those with therapeutic versus nontherapeutic sternotomies were similar with respect to age, mechanisms of injury, injury severity scores, presenting laboratory values, resuscitation fluids, and vital signs. Multiple logistic regression revealed that penetrating trauma (odds ratio: 13.3) and hemodynamic instability (odds ratio: 7.8) were independent predictors of therapeutic sternotomy.


CONCLUSIONS
Hemopericardium per se may be overly sensitive for diagnosing cardiac or great vessel injuries after chest trauma. Some stable blunt or penetrating trauma patients without continuing intrapericardial bleeding had nontherapeutic sternotomies, suggesting that this intervention could be avoided in selected cases.


METHODS
Therapeutic study, level III.
Division of Trauma and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center/Jackson Memorial Hospital, Miami, Florida 33136, USA.
Chad M
CM
Thorson
Nicholas
N
Namias
Robert M
RM
Van Haren
Gerardo A
GA
Guarch
Enrique
E
Ginzburg
Tomas A
TA
Salerno
Carl I
CI
Schulman
Alan S
AS
Livingstone
Kenneth G
KG
Proctor
D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D015999:Multivariate Analysis; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D010491:Pericardial Window Techniques; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery