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Screening for Occult Penetrating Cardiac Injuries

Nicol, Andrew J. PhD, FCS*; Navsaria, Pradeep H. MMed, FCS*; Beningfield, Steve FCRad(D)SA; Hommes, Martijn MD*; Kahn, Delawir ChM, FCS*

doi: 10.1097/SLA.0000000000000713
Original Articles

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.

Emergency department ultrasonography (US) has become the internationally accepted means of screening for a penetrating cardiac injury. The aim of this study was to determine the effectiveness of US in the diagnosis of an occult cardiac injury in the stable patient.

*Trauma Centre, Department of Surgery; and

Department of Radiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.

Reprints: Andrew J. Nicol, FCS, PhD, Trauma Centre, Groote Schuur Hospital, Anzio Rd, Cape Town 7925, South Africa. E-mail:

This paper was presented at the 14th European Congress of Trauma and Emergency Surgery, Lyon, France, May 4–7, 2013, and formed part of a PhD dissertation on the “Current Management of Penetrating Cardiac Trauma” awarded at the University of Cape Town, South Africa in 2012.

Disclosure: The authors declare no conflict of interest.

Supported by the Medical Research Council of South Africa.

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