title: Penetrating cardiac injuries and the evolving management algorithm in the current era.
abstract: BACKGROUND
  Penetrating cardiac injuries carry a significant mortality, especially if operative intervention is delayed because of diagnostic difficulties.
  
  
  METHODS
  We reviewed our experience of 134 consecutive cases over a 6 year period. For the initial 5 years, the diagnosis was based on clinical grounds only. During the final year of study, focused ultrasound focused abdominal sonar for trauma (FAST) and subxiphoid pericardial window were introduced.
  
  
  RESULTS
  Ninety-six per cent (128/134) were males and the overall mean age was 27 y. Eighty-four per cent (112/134) sustained isolated cardiac injury and the remaining sixteen per cent (22/134) had concurrent injuries elsewhere. A total of 10 FAST's were performed and the sensitivity was 20%. Fifteen subxiphoid pericardial window were performed (8 had diagnostic uncertainty, 2 with double jeopardy, and 5 with delayed tamponade) and had a sensitivity of 100%. The survival rate for the 109 patients from the pre-adjunct period was 83% and 88% for the 25 patients in the post-adjunct period, which was not statistically significant (P value = 0.765). There was no significant difference in the complication rate, mean intensive care unit stay, or mean total hospital stay.
  
  
  CONCLUSIONS
  Penetrating cardiac injuries are highly lethal. A high index of suspicion, coupled with early operative intervention remains the key in securing the survival of these patients.
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa. Electronic address: victorywkong@yahoo.com.
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Kong
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa.
authors.forename: George
authors.initials: G
authors.lastname: Oosthuizen
authors.affiliation: Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Benn
authors.initials: B
authors.lastname: Sartorius
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa.
authors.forename: John
authors.initials: J
authors.lastname: Bruce
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa.
authors.forename: Damian L
authors.initials: DL
authors.lastname: Clarke
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D006335:Heart Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D055815:Young Adult
keywords: Cardiac; Penetrating; Thoracotomy