M. Mazzei1, E. Acevedo1, M. Ethridge1, E. Dauer1, Z. Maher1, J. H. Beard1, A. S. Pathak1, T. A. Santora1, A. J. Goldberg1, L. O. Sjoholm1, L. Mason1 1Temple University,Department Of Surgery,Philadelpha, PA, USA
Introduction: The optimal radiographic evaluation of patients with penetrating thoracic trauma is unclear. Thoracic computerized tomography (CT) with IV contrast is widely available as an initial screening test, and many institutions confirm initial findings with routine transthoracic echocardiography (TTE). This is a resource-intensive and time-consuming approach, and it is not clear that TTE provides additional diagnostic accuracy over that of contrast CT alone. We hypothesize that after negative contrast CT, routine TTE does not lead to a change in the diagnosis of penetrating cardiac injuries.
Methods: A retrospective cohort study was conducted of all patients with penetrating thoracic trauma with concern for cardiac involvement at our urban level I trauma center from January 2006 to December 2015. Data was extracted from the trauma registry and the medical record. All patients who underwent TTE to rule out cardiac injury after after a negative contrast chest CT were included. Results and outcomes after imaging were evaluated.
Results: 84 patients with penetrating thoracic injury underwent screening TTE after a negative thoracic CT, including 44.7% with gunshot and 55.3% with stab wounds (avg. ISS 14.7, chest-ISS 2.4). In this population, chest CT with IV contrast showed 100% negative predictive value for cardiac injury. There were no major discordances between TTE and CT; in 38.3 % of cases, TTE was limited by technical difficulty. Minor discordances between TTE and CT (i.e. trivial pericardial effusion) occurred in 15% of patients, but addition of TTE did not result in any changes in management.
Conclusion: In the setting of a negative thoracic CT, TTE provides little additional diagnostic information and should not be routinely used for the evaluation of the patient with penetrating thoracic trauma. Contrast thoracic CT is an acceptable screening test to rule out significant cardiac injuries.