title: Screening for occult penetrating cardiac injuries.
abstract: OBJECTIVE
  To determine the sensitivity of emergency department ultrasonography (US) in the diagnosis of occult cardiac injuries.
  
  
  BACKGROUND
  Internationally, US has become the investigation of choice in screening patients for a possible cardiac injury after penetrating chest trauma by detecting blood in the pericardial sac.
  
  
  METHODS
  Patients presenting with a penetrating chest wound and a possible cardiac injury to the Groote Schuur Hospital Trauma Centre between October 2001 and February 2009 were prospectively evaluated. All patients were hemodynamically stable, had no indication for emergency surgery, and had an US scan followed by subxiphoid pericardial window exploration.
  
  
  RESULTS
  There were a total of 172 patients (median age = 26 years; range, 11-65 years). The mechanism of injury was stab wounds in 166 (96%) and gunshot wounds in 6. The sensitivity of US in detecting hemopericardium was 86.7%, with a positive predictive value of 77%. There were 18 false-negatives. Eleven of these false-negatives had an associated hemothorax and 6 had pneumopericardium. A single patient had 2 negative US examinations and returned with delayed cardiac tamponade.
  
  
  CONCLUSIONS
  The sensitivity of US to detect hemopericardium in stable patients was only 86.7%. The 2 main factors that limit the screening are the presence of a hemothorax and air in the pericardial sac. A new regimen for screening of occult injuries to make allowance for this is proposed.
authors: *Trauma Centre, Department of Surgery; and †Department of Radiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors: Andrew J
authors: AJ
authors: Nicol
authors: Pradeep H
authors: PH
authors: Navsaria
authors: Steve
authors: S
authors: Beningfield
authors: Martijn
authors: M
authors: Hommes
authors: Delawir
authors: D
authors: Kahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D013019:South Africa; D014193:Trauma Centers; D014463:Ultrasonography; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*