title: Penetrating cardiac injuries: A 36-year perspective at an urban, Level I trauma center.
abstract: This study evaluates patterns of injuries and outcomes from penetrating cardiac injuries (PCIs) at Grady Memorial Hospital, an urban, Level I trauma center in Atlanta, Georgia, over 36 years.
  
  
  
  Patients sustaining PCIs were identified from the Trauma Registry of the American College of Surgeons and the Emory Department of Surgery database; data of patients who died prior to any therapy were excluded. Demographics and outcomes were compared over three time intervals: Period 1 (1975-1985; n = 113), Period 2 (1986-1996; n = 79), and Period 3 (2000-2010; n = 79).
  
  
  
  Two hundred seventy-one patients (86% were male; mean age, 33 years; initial base deficit = -11.3 mEq/L) sustained cardiac stab (SW, 60%) or gunshot wounds (GSW, 40%). Emergency department thoracotomy was performed in 67 (25%) of 271 patients. Overall mortality increased in the modern era (Period 1, 27%, vs. Period 2, 22%, vs. Period 3, 42%; p = 0.03) along with GSW mechanisms (Period 1, 32%, vs. Period 2, 33%, vs. Period 3, 57%; p = 0.001), GSW mortality (Period 1, 36%, vs. Period 2, 42%, vs. Period 3, 56%; p = 0.04), and multichamber injuries (Period 1, 12%, vs. Period 2, 10%, vs. Period 3, 34%; p< 0.001). In Period 3, GSWs (n = 45) resulted in multichamber injuries in 28 patients (62%) and multicavity injuries in 19 patients (42%). Surgeon-performed ultrasound accurately identified pericardial blood in 55 of 55 patients in Period 3.
  
  
  
  Increased frequency of GSWs in the past decade is associated with increased overall mortality, multichamber injuries, and multicavity injuries. Ultrasound is sensitive for detection of PCI.
  
  
  
  Therapeutic study, level IV; epidemioligc study, level III.
authors.affiliation: From the Grady Memorial Hospital (B.C.M., M.J.M., R.J., C.J.D., J.U.Z., J.M.N., A.D.W.), Emory University School Medicine, Atlanta, Georgia; Banner Desert Medical Center (J.P.S), Mesa, Arizona; Department of Surgery (G.A.V.), University of Arizona, Tucson, Arizona; Indiana University School of Medicine (G.S.R., D.V.F.), Indianapolis, Indiana.
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Morse
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mina
authors.forename: Jacquelyn S
authors.initials: JS
authors.lastname: Carr
authors.forename: Rashi
authors.initials: R
authors.lastname: Jhunjhunwala
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dente
authors.forename: John U
authors.initials: JU
authors.lastname: Zink
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Nicholas
authors.forename: Amy D
authors.initials: AD
authors.lastname: Wyrzykowski
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Salomone
authors.forename: Gary A
authors.initials: GA
authors.lastname: Vercruysse
authors.forename: Grace S
authors.initials: GS
authors.lastname: Rozycki
authors.forename: David V
authors.initials: DV
authors.lastname: Feliciano
mesh_terms: D000328:Adult; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006335:Heart Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy