1887
Volume 2017, Issue 1
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Cardiac injury is uncommon, but it is important to diagnose, in order to prevent subsequent complications. Extended focused assessment with sonography in trauma (eFAST) allows rapid evaluation of the pericardium and thorax. The objective of this study was to describe cardiac injuries presenting to a major trauma centre and the diagnostic performance of eFAST in detecting haemopericardium as well as broader cardiac injuries. Data of patients with severe injuries and diagnosed cardiac injuries (Injury Severity Score >12 and AIS 2008 codes for cardiac injuries) were extracted from The Alfred Trauma Registry over a four-year period from July 2010 to June 2014. The initial eFAST results were compared to those of the final diagnosis, which were determined after analysing imaging results and intraoperative findings. Thirty patients who were identified with cardiac injuries met the inclusion criteria. Among these, 22 patients sustained injuries under the scope of eFAST, of which a positive eFAST scan in the pericardium was reported in 13 (59%) patients, while nine (41%) patients had a negative scan. This resulted in a sensitivity of 59% (95% CI: 36.7%–78.5%). The sensitivity of detecting any cardiac injuries was lower at 43.3% (95% CI: 26.0–62.3). The low sensitivities of eFAST for detecting cardiac injuries and haemopericardium demonstrate that a negative result cannot be used in isolation to exclude cardiac injuries. A high index of suspicion for cardiac injury remains essential. Adjunct diagnostic modalities are indicated for the diagnosis of cardiac injury following major trauma.

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2017-05-10
2024-03-29
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References

  1. Bansal MK, Maraj S, Chewaproug D, Amanullah A. Myocardial contusion injury: redefining diagnostic algorithm. Emerg Med J. 2005; 22:7:465469.
    [Google Scholar]
  2. Moreno C, Moore EE, Majure JA, Hopeman AR. Pericardial tamponade: A critical determinant for survival following penetrating cardiac wounds. J Trauma. 1986; 26:9:821825.
    [Google Scholar]
  3. Kortbeek JB, Al Turki SA, Ali J, Antoine JA, Bouillon B, Brasel K, Brenneman F, Brink PR, Brohi K, Burris D, Burton RA, Chapleau W, Cioffi W, Collet e Silva Fde S, Cooper A, Cortes JA, Eskesen V, Fildes J, Gautam S, Gruen RL, Gross R, Hansen KS, Henny W, Hollands MJ, Hunt RC, Jover Navalon JM, Kaufmann CR, Knudson P, Koestner A, Kosir R, Larsen CF, Livaudais W, Luchette F, Mao P, McVicker JH, Meredith JW, Mock C, Mori ND, Morrow C, Parks SN, Pereira PM, Pogetti RS, Ravn J, Rhee P, Salomone JP, Schipper IB, Schoettker P, Schreiber MA, Smith RS, Svendsen LB, Taha W, van Wijngaarden-Stephens M, Varga E, Voiglio EJ, Williams D, Winchell RJ, Winter R. Advanced trauma life support, 8th edition, the evidence for change. J Trauma. 2008; 64:6:16381650.
    [Google Scholar]
  4. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010; 17:1:1117.
    [Google Scholar]
  5. Ojaghi Haghighi SH, Adimi I, Shams Vahdati S, Sarkhoshi Khiavi R. Ultrasonographic diagnosis of suspected hemopneumothorax in trauma patients. Trauma Mon. 2014; 19:4:e17498.
    [Google Scholar]
  6. Plummer D. Principles of emergency ultrasound and echocardiography. Ann Emerg Med. 1989; 18::12911297.
    [Google Scholar]
  7. Rozycki GS, Feliciano DV, Ochsner MG, Knudson MM, Hoyt DB, Davis F, Hammerman D, Figueredo V, Harviel JD, Han DC, Schmidt JA. The role of ultrasound in patients with possible penetrating cardiac wounds: A prospective multicenter study. J Trauma. 1999; 46:4:543552.
    [Google Scholar]
  8. Tayal VS, Beatty MA, Marx JA, Tomaszewski CA, Thomason MH. FAST (focused assessment with sonography in trauma) accurate for cardiac and intraperitoneal injury in penetrating anterior chest trauma. J Ultrasound Med. 2004; 23:4:467472.
    [Google Scholar]
  9. Ball CG, Williams BH, Wyrzykowski AD, Nicholas JM, Rozycki GS, Feliciano DV. A caveat to the performance of pericardial ultrasound in patients with penetrating cardiac wounds. J Trauma. 2009; 67:5:11231234.
    [Google Scholar]
  10. Baker L, Almadani A, Ball CG. False negative pericardial focused assessment with sonography for trauma examination following cardiac rupture from blunt thoracic trauma: a case report. J Med Case Rep. 2015; 9::155.
    [Google Scholar]
  11. Kong VY, Oosthuizen G, Sartorius B, Bruce J, Clarke DL. Penetrating cardiac injuries and the evolving management algorithm in the current era. Journal of Surgical Research. 2015; 193:2:926932.
    [Google Scholar]
  12. Kirkpatrick A, Sirois M, Laupland K, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, Hamiilton DR, Nicolaou S. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: The extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004; 57:2:288295.
    [Google Scholar]
  13. Cameron PA, Gabbe BJ, Smith K, Mitra B. Triaging the right patient to the right place in the shortest time. Br J Anaesth. 2014; 113:2:226233.
    [Google Scholar]
  14. Olaussen A, Blackburn T, Mitra B, Fitzgerald M. Review article: shock index for prediction of critical bleeding post-trauma: A systematic review. Emerg Med Australas. 2014; 26:3:223228.
    [Google Scholar]
  15. Blaivas M, DeBehnke D, Phelan MB. Potential errors in the diagnosis of pericardial effusion on trauma ultrasound for penetrating injuries. Acad Emerg Med. 2000; 7:11:12611266.
    [Google Scholar]
  16. Abdulrahman Y, Musthafa S, Hakim SY, Nabir S, Qanbar A, Mahmood I, Siddiqui T, Hussein WA, Ali HH, Afifi I, El-Menyar A, Al-Thani H. Utility of extended FAST in blunt chest trauma: is it the time to be used in the ATLS algorithm? World J Surg. 2015; 39:1:172178.
    [Google Scholar]
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  • Article Type: Research Article
Keyword(s): cardiac injuryeFASTFASTultrasound and wounds and injuries
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