EMERGENCY DEPARTMENT ECHOCARDIOGRAPHY IMPROVES OUTCOME IN PENETRATING CARDIAC INJURY

Study objectives: To determine the effect of immediate two-dimensional echocardiography on the time to diagnosis, survival rate, and neurologic outcome of patients with penetrating cardiac injury. Design: A ten-year retrospective review. Setting: Regional trauma center serving a population base of 1.25 million with 85,000 visits yearly. Type of participants: All patients presenting to the emergency department with penetrating cardiac injury. Measurements and main results: The records of 49 patients with penetrating cardiac injury were reviewed. Of these, 28 received immediate two-dimensional echocardiography in the ED (echo group) and 21 did not (nonecho group). The probability of survival was derived using TRISS methodology. Differences between groups were determined using either the two sample t-test for parametric data or the Mann-Whitney test for nonparametric data. The overall probability of survival was 33.2%, and the actual survival rate was 81.6%. The probability of survival was 34.2% and 31.8% for the echo group and nonecho group, respectively. The actual survival was 100% in the echo group and 57.1% in the nonecho group. The average time to diagnosis and disposition for surgical intervention was 15.5 +/- 11.4 minutes for the echo group and 42.4 +/- 21.7 minutes for the nonecho group (P < .001). The Glasgow Outcome Score was 5.0 for the echo group and 4.2 for the nonecho group (P = .007). Conclusion: Since the introduction of immediate ED two-dimensional echocardiography, the time to diagnosis of penetrating cardiac injury has decreased and both the survival rate and neurologic outcome of survivors has improved.