Does hemopericardium after chest trauma mandate sternotomy?

Chad M. Thorson, Nicholas Namias, Robert M. Van Haren, Gerardo A. Guarch, Enrique Ginzburg, Tomas Salerno, Carl I Schulman, Alan Livingstone, Kenneth G Proctor

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

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

Original languageEnglish
Pages (from-to)1518-1525
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number6
DOIs
StatePublished - Jun 1 2012

Fingerprint

Sternotomy
Pericardial Effusion
Thorax
Wounds and Injuries
Resuscitation
Odds Ratio
Thoracic Injuries
Injury Severity Score
Vital Signs
Lacerations
Trauma Centers
Logistic Models
Hemodynamics
Hemorrhage

Keywords

  • Cardiac injury
  • Pericardial window
  • Sonography

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Does hemopericardium after chest trauma mandate sternotomy? / Thorson, Chad M.; Namias, Nicholas; Van Haren, Robert M.; Guarch, Gerardo A.; Ginzburg, Enrique; Salerno, Tomas; Schulman, Carl I; Livingstone, Alan; Proctor, Kenneth G.

In: Journal of Trauma and Acute Care Surgery, Vol. 72, No. 6, 01.06.2012, p. 1518-1525.

Research output: Contribution to journalArticle

@article{5db557f319894a65b43a29ad2b3cd1b3,
title = "Does hemopericardium after chest trauma mandate sternotomy?",
abstract = "BACKGROUND: Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether thesewere rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy. METHOD: 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 PCWproceeded 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. CONCLUSION: 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.",
keywords = "Cardiac injury, Pericardial window, Sonography",
author = "Thorson, {Chad M.} and Nicholas Namias and {Van Haren}, {Robert M.} and Guarch, {Gerardo A.} and Enrique Ginzburg and Tomas Salerno and Schulman, {Carl I} and Alan Livingstone and Proctor, {Kenneth G}",
year = "2012",
month = "6",
day = "1",
doi = "10.1097/TA.0b013e318254306e",
language = "English",
volume = "72",
pages = "1518--1525",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Does hemopericardium after chest trauma mandate sternotomy?

AU - Thorson, Chad M.

AU - Namias, Nicholas

AU - Van Haren, Robert M.

AU - Guarch, Gerardo A.

AU - Ginzburg, Enrique

AU - Salerno, Tomas

AU - Schulman, Carl I

AU - Livingstone, Alan

AU - Proctor, Kenneth G

PY - 2012/6/1

Y1 - 2012/6/1

N2 - BACKGROUND: Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether thesewere rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy. METHOD: 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 PCWproceeded 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. CONCLUSION: 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.

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

KW - Cardiac injury

KW - Pericardial window

KW - Sonography

UR - http://www.scopus.com/inward/record.url?scp=84864245603&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864245603&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e318254306e

DO - 10.1097/TA.0b013e318254306e

M3 - Article

C2 - 22695415

AN - SCOPUS:84864245603

VL - 72

SP - 1518

EP - 1525

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6

ER -