Journal article
Penetrating cardiac injuries: predictive model for outcomes based on 2016 patients from the National Trauma Data Bank
European journal of trauma and emergency surgery (Munich : 2007), Vol.44(6), pp.835-841
12/2018
DOI: 10.1007/s00068-017-0806-6
PMID: 28578468
Abstract
Penetrating cardiac injuries are uncommon and lethal. The objectives of this study are to examine the national profile of cardiac injuries, identify independent predictors of outcome, generate, compare and validate previous predictive models for outcomes. We hypothesized that National Trauma Data Bank (NTDB) given its large number of patients, would validate these models.
The NTDB was queried for data on cardiac injuries, using survival as the main outcome measure. Statistical analysis was performed utilizing univariate and stepwise logistic regression. The stepwise logistic regression model was then compared with other predictive models of outcome.
There were 2016 patients with penetrating cardiac injuries identified from 1,310,720 patients. Incidence: 0.16%. Mechanism of injury: GSWs-1264 (63%), SWs-716 (36%), Shotgun/impalement-19/16 (1%). Mean RTS 1.75, mean ISS 27 ± 23. Overall survival 675 (33%). 830 patients (41%) underwent ED thoracotomy, 47 survived (6%). Survival stratified by mechanism: GSWs 114/1264 (10%), SWs 564/717 (76%). Predictors of outcome for mortality-univariate analysis: vital signs, RTS, ISS, GCS: Field CPR, ED intubation, ED thoracotomy and aortic cross-clamping (p < 0.001). Stepwise logistic regression identified cardiac GSW's (p < 0.001; AOR 26.85; 95% CI 17.21-41.89), field CPR (p = 0.003; AOR 3.65; 95% CI 1.53-8.69), the absence of spontaneous ventilation (p = 0.008; AOR 1.08, 95% CI 1.02-1.14), the presence of an associated abdominal GSW (p = 0.009; AOR 2.58, 95% CI 1.26-5.26) need for ED airway (p = 0.0003 AOR 1386.30; 95% CI 126.0-15251.71) and aortic cross-clamping (p = 0.0003 AOR 0.18; 95% CI 0.11-0.28) as independent predictors for mortality. Overall predictive power of model-93%.
Predictors of outcome were identified. Overall survival rates are lower than prospective studies report. Predictive model from NTDB generated larger number of strong independent predictors of outcomes, correlated and validated previous predictive models.
Details
- Title: Subtitle
- Penetrating cardiac injuries: predictive model for outcomes based on 2016 patients from the National Trauma Data Bank
- Creators
- J A Asensio - Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3701, Omaha, NE, 68131-2137, USA. JuanAsensio@creighton.eduO A Ogun - Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USAP Petrone - Department of Surgery, New York Medical College, Valhalla, New York, USAA J Perez-Alonso - Department of Surgery, University of Granada, Granada, Andalucia, SpainM Wagner - Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USAR Bertellotti - Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USAB Phillips - Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USAD L Cornell - Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USAA O Udekwu - Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA
- Resource Type
- Journal article
- Publication Details
- European journal of trauma and emergency surgery (Munich : 2007), Vol.44(6), pp.835-841
- Publisher
- Germany
- DOI
- 10.1007/s00068-017-0806-6
- PMID
- 28578468
- ISSN
- 1863-9933
- eISSN
- 1863-9941
- Language
- English
- Date published
- 12/2018
- Academic Unit
- Surgery
- Record Identifier
- 9984051982302771
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