CARDIAC INJURIES - ANALYSIS OF AN UNSELECTED SERIES OF 251 CASES

Retrospective analysis was performed on the medical records of 251 pat ients treated for cardiac injuries at Highland General Hospital trauma facility in Alameda County, California, to identify factors that cont ribute to patient survival and predict death. Thirty-six patients (14% ) had blunt injuries, 153 patients (61%) had gunshot wounds (GSW), and 62 patients (25%) had stab wounds. Theoverall survival rate was 18.7% , GSW survival was 6.5%, stab wound survival was 37.1%, and blunt inju ry survival was 40%. Patients who arrived with some vital signs had 62 .2% survival and patients who arrived with absent vital signs had <1% survival. Stepwise multiple logistic regression analysis revealed that for patients with absent vital signs the only significant predictor of outcome was GSW as the mechanism of injury and for patients with vita l signs the ISSand the presence of combined right and left heart injur ies were significant independent predictors of outcome. We conclude th at the routine and aggressive use of emergency room thoracotomy for pa tients with penetrating cardiac injurymust be re-examined.