Clinical sequelae from blunt cardiac trauma (BCT) may range from minor electrocardiographic abnormalities to death from free-wall rupture. There are no established clinical characteristics or injury scoring systems that are able to predict survival in these patients.
A retrospective review of medical records from a Level I trauma center identified 47 patients with BCT. A grade assigned on the basis of the American Association for the Surgery of Trauma Organ Injury Scale (OIS) was assigned to each case studied. Clinical data, including the Injury Severity Score (ISS), and outcomes were analyzed for association with OIS grade.
The average ISS was 27.9, and the overall mortality rate was 31.9%. The majority of patients were either grade II or IV, with the latter having the highest mortality. Hypotension at admission, cardiac arrest, lack of vital signs at admission, ISS, hours to diagnosis, and death all had significant association with assigned OIS grade. Factors associated with mortality included ISS; OIS grade; shorter time to diagnosis; cardiac tamponade; cardiac rupture; lack of vital signs at admission; and concomitant injury to either the thoracic aorta or to the liver, spleen, or kidneys.
The OIS grade, assigned on the basis of anatomic site of injury and electrocardiographic abnormalities, appears to correlate with severity of injury and survival. Although injury scoring should not be used exclusively to guide management in trauma patients, the grading system studied may be useful in predicting outcomes in patients with BCT.
From the Department of Surgery, Division of Cardiac Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center (R.A.L.), Worcester, and Department of Surgery, Beth Israel-Deaconess Medical Center (T.S.M.), Boston, Massachusetts.
Submitted for publication October 12, 2001.
Accepted for publication May 21, 2002.
Address for reprints: Robert A. Lancey, MD, Division of Cardiac Surgery, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655; email: email@example.com.