Background Penetrating cardiac injuries are among the most lethal of all injuries to the chest. Management of these injuries has significantly evolved over the past 15 years, with increased utilization of noninvasive diagnostic tests. Bedside echocardiography can provide immediate and accurate information regarding the heart and pericardium and the need for immediate surgery. It is standard of care to perform transthoracic cardiac ultrasonography in these cases. In some medical centers either echocardiogram technicians or cardiology fellows are required to come in after hours and perform the echocardiography. We sought to retrospectively study the utility of urgent echocardiography in the setting of hemodynamically stable patients with penetrating chest trauma in our institution to provide better resource utilization for this patient population.
Methods Between January 2003 and June 2006, 49 hemodynamically stable patients with penetrating trauma to the chest were evaluated with an emergent echocardiogram in our emergency department. Data were collected from chart review and echocardiogram results.
Results Of the 49 patients reviewed, 80% were male. The average age was 32 years (17-75), presenting systolic blood pressure (BP) was 131 mm Hg (97-188), diastolic BP was 77 mm Hg (43-106), and heart rate was 100 bpm (65-130). Forty of the 49 patients had no pericardial effusion on echocardiogram. Nine echocardiograms revealed small effusions. One showed anterior effusion versus adipose tissue, which led to a subcostal pericardial window, with serous fluid removed. Ten patients had a pneumothorax or hemothorax. One patient with no effusion on transthoracic echocardiogram was confirmed to have bullet pellets in the intraventricular septum on transesophageal echocardiogram but had no further testing or surgery.
Conclusion In reviewing the current trauma and emergency medicine literature it is standard of care to obtain two chest radiographs in a span of 6 hours and an echocardiogram to evaluate for possible hemopericardium in any hemodynamically stable patient with penetrating trauma to the chest. However, our review found that in this patient population an urgent echocardiogram has very low yield and did not change patient care. We suggest that in this patient population an echocardiogram after hours may not be necessary
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