Point of Care Cardiac Ultrasound and New Injury Severity Score for Diagnosis of Hemorrhagic Pericardial Effusion after Penetrating Thoracic Trauma

Farag, Gamal Abdelshafy Ibrahim; Hitawy, Mohamed Abdelaziem; Abd El-Salam, Ahmed Bedeir

doi:10.21608/ijma.2024.312150.2019

Point of Care Cardiac Ultrasound and New Injury Severity Score for Diagnosis of Hemorrhagic Pericardial Effusion after Penetrating Thoracic Trauma

Document Type : Original Article

Authors

¹ Department of Cardiothoracic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

² Department of Radiology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

10.21608/ijma.2024.312150.2019

Abstract

Background: Ultrasound is used for trauma patients for rapid detection and assessment, permitting early treatment intervention. Its use in the recognition of pericardial effusion [PCE] hemopericardium in penetrating chest trauma gained attention in recent years to prevent rapid deterioration of hemodynamics of these patients.
Aim of the study: This study aimed to evaluate the diagnostic power of ultrasound for PCE hemopericardium after penetrating cardiac trauma.
Patients and Methods: This was a retrospective study included patients presented with penetrating chest trauma and suspected PCE hemopericardium. The collected data included personal characteristics, admission hemodynamic data, new injury severity score [NISS], Glasgow Coma Scale [GCS], mechanism of injury, results of ultrasound, duration of hospital stay, and in-hospital mortality. The results of ultrasound were compared to the results of intraoperative data [as the gold-standard diagnostic method].
Results: The PCE hemopericardium was confirmed for 42 patient [65.6%]. Patients with PCE hemopericardium had significantly higher NISS, duration of hospital stay, and in-hospital mortality and significantly lower GCS at admission. Duration of stay ranged between 6-15 days, and in-hospital mortality was reported for 7 patients [10.9%], all were from those who developed PCE hemopericardium. The ultrasound detected 45 patients with PCE hemopericardium, 42 of them were confirmed intraoperatively [True positive] and it detected 19 patients without PCE hemopericardium, all were confirmed intraoperatively. Thus, the sensitivity, specificity, PPV and NPV were 93.3%, 100.0%, 100.0%, 86.4% successively. At a cutoff value > 25, the NISS had a 64.29% and 90.91% sensitivity and specificity respectively. Older age, lower admission blood pressure, higher injury severity score are associated with in-hospital mortality.
Conclusion: Ultrasound can be considered as a reliable diagnostic tool for the rapid recognition of pericardial effusion hemopericardium in penetrating chest trauma. Thus, permitting early intervention and prevent hemodynamic deterioration.

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