Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 199-214).

In the Republic of South Africa, an autopsy is required in all cases of unnatural death, or in cases where the cause of death is unknown in terms of the Inquest Act of 1959. These are performed at the Salt River Medicolegal Laboratory by Forensic Pathologists and Registrars of the Department of Forensic Medicine and Toxicology of the University of Cape Town. The Salt River Medicolegal Laboratory serves the greater Cape Town area with a population of approximately 2,5 million, including the magisterial districts of Cape Town, Wynberg, Mitchell's Plain and Simonstown. Cape Town has one of the world's highest homicide rates and in 1986 the incidence was 56, 91 100000 population per annum. In contrast, Singapore has a homicide rate of only 2, 5/100 000, while the United States has an overall homicide rate of 7,7/ 100 000 population. In order to document the true impact of penetrating chest injuries, and to place mortality data in perspective, a retrospective descriptive study of all cases with fatal penetrating chest injuries admitted to the Salt River Medicolegal Laboratory in Cape Town during 1990 was undertaken. In 1990, a total of 5 758 cases was admitted to the Salt River Medicolegal Laboratory of which 1834 cases (39%) were the result of homicide. Of the homicide cases, 408 (22%) were the result of firearm injuries. A total of 2044 (35, 5%) cases admitted was deemed to have died of natural causes. This study identified a total of 841 cases of fatal penetrating injuries of the chest admitted during 1990, which constituted 22,6% of all non-natural cases admitted.

Orientador: Gustavo Pereira Fraga / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T03:18:47Z (GMT). No. of bitstreams: 1 Pereira_BrunoMonteiroTavares_D.pdf: 9308561 bytes, checksum: d9bbcf8aaa7de38fba06e5228f9dccd3 (MD5) Previous issue date: 2014 / Resumo: Introdução: Trauma penetrante é atualmente a principal causa de trauma cardíaco. O objetivo deste estudo é descrever e comparar as variáveis entre os pacientes com trauma cardíaco penetrante nos últimos 20 anos em um hospital universitário identificando fatores de risco para morbidade e mortalidade. Métodos: Revisão de dados de registro de trauma, seguido por análise estatística descritiva comparando os períodos 1990 a 1999 (grupo 1 , 54 casos) e 2000 a 2009 (grupo 2, 39 casos). Foram registrados dados clínicos no momento da internação hospitalar, o Índice de Gravidade da Lesão (ISS), Escala de Coma de Glasgow (GCS), e o Escore de Trauma Revisado (RTS). Resultados: A incidência de ferimentos cardíacos penetrantes foram constantes dentro do período de estudo. Os dois grupos foram semelhantes quanto à idade, mecanismo de trauma (ferimento por projétil de arma de fogo ou branca) e ISS. Grupo 1 apresentou menor pressão arterial sistólica na admissão (média de 87 contra 109 mmHg), menor GCS (12,9 vs. 14,1), RTS mais baixo (6,4 vs. 7,3), maior incidência de lesões cardíacas graus IV e V (74% vs. 48,7%), e foram menos propensos a sobreviver (0,83 contra 0,93). O principal fator de risco para o óbito foi ferimento por projétil de arma de fogo (13 vezes maior do que por arma branca), pressão arterial sistólica <90 mm Hg , GCS <8 , RTS <7,84 , lesões associadas, lesões grau IV e V e ISS >25. Observou-se uma tendência na redução de mortalidade de 20,3% para 10,3% durante o período de observação. Conclusões: Foram identificados vários fatores associados à mortalidade e morbidade. Na última década, os pacientes foram admitidos em melhor condição fisiológica, talvez refletindo uma melhora no tratamento pré-hospitalar. Observou-se uma tendência para uma menor taxa de mortalidade / Abstract: Background: Penetrating traumas, including gunshot and stab wounds, are the major causes of cardiac trauma. Our aim was to describe and compare the variables between patients with penetrating cardiac trauma in the past 20 years in a university hospital, identifying risk factors for morbidity and death. Methods: Review of trauma registry data followed by descriptive statistical analysis comparing the periods 1990 to 1999 (group 1, 54 cases) and 2000 to 2009 (group 2, 39 cases). Clinical data at hospital admission, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS) were recorded. Results: The incidences of penetrating cardiac injuries were steady within the period of study in the chosen metropolitan area. The two groups were similar regarding age, mechanism of trauma (gunshot stab), and ISS. Group 1 showed lower systolic blood pressure at admission (mean 87 versus 109 mm Hg), lower GCS (12.9 versus 14.1), lower RTS (6.4 versus 7.3), higher incidence of grade IV and V cardiac lesions (74% versus 48.7%), and were less likely to survive (0.83 versus 0.93). The major risk factor for death was gunshot wound (13 times higher than stab wound), systolic blood pressure <90 mm Hg, GCS <8, RTS <7.84, associated injuries, grade IV and V injury, and ISS >25. We observed a tendency in mortality reduction from 20.3% to 10.3% within the period of observation. Conclusions: Several associated factors for mortality and morbidity were identified. In the last decade, patients were admitted in better physiological condition, perhaps reflecting an improvement on pre-hospital treatment. We observed a trend toward a lower mortality rate / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências