THE ROLE OF SURGEON-PERFORMED ULTRASOUND IN PATIENTS WITH POSSIBLE CARDIAC WOUNDS

Objective The authors evaluate surgeon-performed ultrasound in determi ning the need for operation in patients with possible cardiac wounds. Background Data Ultrasound quickly is becoming part of the surgeon's d iagnostic armamentarium; however, its role for the patient with penetr ating injury is less well-defined. Although accurate for the detection of hemopericardium, the lack of immediate availability of the cardiol ogist to perform the test may delay the diagnosis, adversely affecting patient outcome. To be an effective diagnostic test in trauma centers , ultrasound must be immediately available in the resuscitation area a nd performed and interpreted by surgeons. Methods Surgeons performed p ericardial ultrasound examinations on patients with penetrating trunca l wounds but no immediate indication for operation. The subcostal view detected hemopericardium, and patients with positive examinations und erwent immediate operation by the same surgeon. Vital signs, base defi cit, time from examination to operation, operative findings, treatment , and outcome were recorded. Results During 13 months, 247 patients ha d surgeon-performed ultrasound. There were 236 true-negative and 10 tr ue-positive results, and no false-negative or false-positive results, however, the pericardial region could not be visualized in one patient . Sensitivity, specificity, and accuracy were 100%; mean examination t ime was 0.8 minute (246 patients). Of the ten true-positive examinatio ns, three were hypotensive. The mean time (8 patients) from ultrasound to operation was 12.1 minutes; all survived. Operative findings (site of cardiac wounds) were: left ventricle (4), right ventricle (3), rig ht atrium (2), right atrium/superior vena cava(1), and right atrium/in ferior vena cava(1). Conclusions Surgeon-performed ultrasound is a rap id and accurate technique for diagnosing hemopericardium. Delay times from admission to operating room are minimized when the surgeon perfor ms the ultrasound examination.