Introduction: One in 11.5 patients with a thoracic wound has cardiac involvement with
potentially life-threatening consequences. Therefore, cardiac injury must be assumed in
every patient with a penetrating chest lesion, even if the patient is haemodynamically
stable. A need exists to diagnose or screen for “occult” cardiac injury.
Methods: A retrospective analysis was conducted in patients with a penetrating injury to
the chest at Charlotte Maxeke Johannesburg Academic Hospital Trauma Unit from 1
January 2007 to 30 June 2010. Data was compared between patients with and without
cardiac injury. Clinical examination and special investigations were assessed for
sensitivity, specificity, positive and negative predictive values.
Results: Of 7 781 major injuries assessed, 1 591 (20%) sustained a penetrating injury to
the chest. All cardiac injury was incurred through a precordial wound. Two investigations
were found to be both significant and useful. Transthoracic echocardiography (TTE) had a
sensitivity of 100% and specificity of 95%. Serial Troponin T (Trop T) levels showed a
peak at 4 hours and by 6 hours post admission the specificity and negative predictive
values were 100%.
Conclusion: Of the investigations examined, TTE was found to have the best results. The
need for specialised equipment and training make TTE less practical in a resource-limited
environment. Serial Trop T shows a high negative predictive value and is a cost effective
screening test for penetrating cardiac injury.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/15482 |
| Date | 10 September 2014 |
| Creators | Surridge, Daniel Johnathan David |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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