Penetrating cardiac trauma in adolescents: A rare injury with excessive mortality

  • Thomas Lustenberger
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA
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  • Peep Talving
    Correspondence
    Corresponding author. University of Southern California-Keck School of Medicine, Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Los Angeles County General Hospital (LAC + USC), Los Angeles, CA, 90033-4525, USA. Tel.: +1 323 4098604; fax: +1 323 4419909.
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA
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  • Lydia Lam
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA
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  • Kenji Inaba
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA
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  • Shahin Mohseni
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA
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  • Jennifer Ann Smith
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA
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  • Demetrios Demetriades
    Affiliations
    Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, Los Angeles County+University of Southern California Medical Center, Los Angeles, CA, USA
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      Abstract

      Background

      Penetrating cardiac injuries in pediatric patients are rarely encountered. Likewise, the in-hospital outcome measures following these injuries are poorly described.

      Methods

      All pediatric patients (<18 years) sustaining penetrating cardiac injuries between 1/2000 and 12/2010 were retrospectively identified using the trauma registry of an urban level I trauma center. Demographic and admission variables, operative findings, and hospital course were extracted. Outpatient follow-up data were obtained through chart reviews and cardiac-specific imaging studies.

      Results

      During the 11-year study period, 32 of the 4569 pediatric trauma admissions (0.7%) sustained penetrating cardiac injuries. All patients were male and the majority suffered stab wounds (81.2%). The mean systolic blood pressure on admission was 28.8±52.9 mmHg and the mean ISS was 46.9±27.7. Cardiac chambers involved were the right ventricle (46.9%), the left ventricle (43.8%), and the right atrium (18.8%). Overall, 9 patients (28.1%) survived to hospital discharge. Outpatient follow-up echocardiography was available for 4 patients (44.4%). An abnormal echocardiography result was found in 1 patient, demonstrating hypokinesia and tricuspid regurgitation.

      Conclusions

      Penetrating cardiac trauma is a rare injury in the pediatric population. Cardiac chambers predominantly involved are the right and left ventricles. This injury is associated with a low in-hospital survival (<30%).

      Key words

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