Penetrating Cardiac Injuries: Outcome of Treatment from a Level 1 Trauma Centre in South Africa
Background: Penetrating cardiac injuries are rare in South African and international literature. Penetrating cardiac injuries are regarded as one of the most lethal injuries in trauma patients. The mechanism of injury varies across the world. In developing countries, stab wounds cause the majority o...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-05-01
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| Series: | Trauma Care |
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| Online Access: | https://www.mdpi.com/2673-866X/2/2/21 |
| _version_ | 1827656176757637120 |
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| author | Shumani Makhadi Maeyane Stephens Moeng Chikwendu Ede Farhana Jassat Sechaba Thabo Palweni |
| author_facet | Shumani Makhadi Maeyane Stephens Moeng Chikwendu Ede Farhana Jassat Sechaba Thabo Palweni |
| author_sort | Shumani Makhadi |
| collection | DOAJ |
| description | Background: Penetrating cardiac injuries are rare in South African and international literature. Penetrating cardiac injuries are regarded as one of the most lethal injuries in trauma patients. The mechanism of injury varies across the world. In developing countries, stab wounds cause the majority of penetrating cardiac injuries. These injuries remain clinically challenging and are associated with high mortalities. Aim: To describe our experience with penetrating cardiac injuries and the outcome of their management at a level 1 trauma unit in Johannesburg, South Africa. Materials and methods: We retrospectively reviewed all patients who presented with penetrating cardiac injuries over a period of four years (1 January 2016 to 31 December 2019). The patients were identified using the hospital database. The patient’s demographics, mechanism of injury, injury severity score, vital signs, investigation findings, final diagnosis, type of operation, length of hospital stay, morbidities, and mortalities were recorded. Results: There was a total of 167 patients with penetrating cardiac injuries identified. There were 151 (90.4%) males, with an overall median age of 29 years (IQR 24–34). Stab wounds accounted for 77.8% of the injuries, while gunshot wounds (GSW) accounted for 22.2%. The median injury severity score (ISS) and revised trauma score (RTS) were 25 and 7.1, respectively. The right ventricle was the most injured chamber (34.7%), followed by the left ventricle (29.3%), right auricle (13.2%), right atrium (10.2%), and combined injuries accounted for 7% of injuries. A commonly used incision was a sternotomy (51.5%), left anterior-lateral thoracotomy (26.9%), emergency room thoracotomy (19.2%), and clamshell thoracotomy (2.4%). The overall mortality rate was 40.7%, with a 29.2% mortality in the stab wounds. Twenty-four (14.4%) patients died in the emergency department, sixteen (9.6%) patients died on the table in theatre, and the remaining twenty-eight (16.7%) died in the intensive care unit or wards. Gunshot wounds, other associated injuries, right ventricle injuries, a high ISS, low RTS, and low Glasgow coma scale were all significantly more likely to result in death (<i>p</i> < 0.001). Conclusions: Penetrating cardiac injuries are often fatal, but the mortality can be improved with appropriate resuscitation and a work-up. The injuries to the heart can be safely managed by trauma/general surgeons in our setting. The physiology in presentation and other associated injuries determines outcomes in patients with penetrating cardiac injury. |
| first_indexed | 2024-03-09T22:18:56Z |
| format | Article |
| id | doaj.art-202729a922b7474d987dee269dde5f67 |
| institution | Directory Open Access Journal |
| issn | 2673-866X |
| language | English |
| last_indexed | 2024-03-09T22:18:56Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Trauma Care |
| spelling | doaj.art-202729a922b7474d987dee269dde5f672023-11-23T19:18:03ZengMDPI AGTrauma Care2673-866X2022-05-012225125910.3390/traumacare2020021Penetrating Cardiac Injuries: Outcome of Treatment from a Level 1 Trauma Centre in South AfricaShumani Makhadi0Maeyane Stephens Moeng1Chikwendu Ede2Farhana Jassat3Sechaba Thabo Palweni4Department of Surgery, Trauma Unit, Charlotte Maxeke Academic Hospital, University of Witwatersrand, Johannesburg 2193, South AfricaDepartment of Surgery, Trauma Unit, Charlotte Maxeke Academic Hospital, University of Witwatersrand, Johannesburg 2193, South AfricaDepartment of Surgery, Trauma Unit, Charlotte Maxeke Academic Hospital, University of Witwatersrand, Johannesburg 2193, South AfricaDepartment of Surgery, Trauma Unit, Charlotte Maxeke Academic Hospital, University of Witwatersrand, Johannesburg 2193, South AfricaDepartment of Surgery, Trauma Unit, Charlotte Maxeke Academic Hospital, University of Witwatersrand, Johannesburg 2193, South AfricaBackground: Penetrating cardiac injuries are rare in South African and international literature. Penetrating cardiac injuries are regarded as one of the most lethal injuries in trauma patients. The mechanism of injury varies across the world. In developing countries, stab wounds cause the majority of penetrating cardiac injuries. These injuries remain clinically challenging and are associated with high mortalities. Aim: To describe our experience with penetrating cardiac injuries and the outcome of their management at a level 1 trauma unit in Johannesburg, South Africa. Materials and methods: We retrospectively reviewed all patients who presented with penetrating cardiac injuries over a period of four years (1 January 2016 to 31 December 2019). The patients were identified using the hospital database. The patient’s demographics, mechanism of injury, injury severity score, vital signs, investigation findings, final diagnosis, type of operation, length of hospital stay, morbidities, and mortalities were recorded. Results: There was a total of 167 patients with penetrating cardiac injuries identified. There were 151 (90.4%) males, with an overall median age of 29 years (IQR 24–34). Stab wounds accounted for 77.8% of the injuries, while gunshot wounds (GSW) accounted for 22.2%. The median injury severity score (ISS) and revised trauma score (RTS) were 25 and 7.1, respectively. The right ventricle was the most injured chamber (34.7%), followed by the left ventricle (29.3%), right auricle (13.2%), right atrium (10.2%), and combined injuries accounted for 7% of injuries. A commonly used incision was a sternotomy (51.5%), left anterior-lateral thoracotomy (26.9%), emergency room thoracotomy (19.2%), and clamshell thoracotomy (2.4%). The overall mortality rate was 40.7%, with a 29.2% mortality in the stab wounds. Twenty-four (14.4%) patients died in the emergency department, sixteen (9.6%) patients died on the table in theatre, and the remaining twenty-eight (16.7%) died in the intensive care unit or wards. Gunshot wounds, other associated injuries, right ventricle injuries, a high ISS, low RTS, and low Glasgow coma scale were all significantly more likely to result in death (<i>p</i> < 0.001). Conclusions: Penetrating cardiac injuries are often fatal, but the mortality can be improved with appropriate resuscitation and a work-up. The injuries to the heart can be safely managed by trauma/general surgeons in our setting. The physiology in presentation and other associated injuries determines outcomes in patients with penetrating cardiac injury.https://www.mdpi.com/2673-866X/2/2/21cardiac injurystab woundsgunshot woundsthoracotomy |
| spellingShingle | Shumani Makhadi Maeyane Stephens Moeng Chikwendu Ede Farhana Jassat Sechaba Thabo Palweni Penetrating Cardiac Injuries: Outcome of Treatment from a Level 1 Trauma Centre in South Africa Trauma Care cardiac injury stab wounds gunshot wounds thoracotomy |
| title | Penetrating Cardiac Injuries: Outcome of Treatment from a Level 1 Trauma Centre in South Africa |
| title_full | Penetrating Cardiac Injuries: Outcome of Treatment from a Level 1 Trauma Centre in South Africa |
| title_fullStr | Penetrating Cardiac Injuries: Outcome of Treatment from a Level 1 Trauma Centre in South Africa |
| title_full_unstemmed | Penetrating Cardiac Injuries: Outcome of Treatment from a Level 1 Trauma Centre in South Africa |
| title_short | Penetrating Cardiac Injuries: Outcome of Treatment from a Level 1 Trauma Centre in South Africa |
| title_sort | penetrating cardiac injuries outcome of treatment from a level 1 trauma centre in south africa |
| topic | cardiac injury stab wounds gunshot wounds thoracotomy |
| url | https://www.mdpi.com/2673-866X/2/2/21 |
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