Outcome of penetrating cardiac injuries in southern Iran, Shiraz

Objective： Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz. Methods： From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study. Results： The study consisted of 37 patients, including 1 gunshot wound （2.7%）, 35 stab wounds （94.6%） and 1 （2.7%） shotgun wound. The overall survival rate was 76% （28 in 37） and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed sig- nificant correlation between mortality and electrocardio- graphic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type （gunshot more than stab wound）. Conclusion： Our results show that injury mechanism and initial cardiac rhythm are significant predictors of out- comes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality.

Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria:Established novel criteria for trauma victims

Propose:In this study,we re-assessed the criteria defined by the radiological society of North America(RSNA)to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.Methods:All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion,COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020.Included patients(Group P)were then classified into two groups based on polymerase chain reaction tests(Group Pa for positive patients and Pb for negative ones).Moreover,44 patients from the prepandemic period(Group PP)were enrolled.They were matched to Group P regarding age,sex,and trauma-related scores.Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria.The radiological findings were compared between Group P and Group PP;statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter.Finally,the sensitivity and specificity of each significant findings were calculated.The Chi-square test was used to compare the radiologica丨findings between Group P and Group PP.Results:In the Group PP,73.7%of all ground-glass opacities(GGOs)and 80%of all multiple bilateral GGOs were detected(p<0.001 and p=0.25,respectively).Single bilateral GGOs were only seen among the Group PP.The Chi-square tests showed that the prevalence of diffused GGOs,multiple unilateral GGOs,multiple consolidations,and multiple bilateral consolidations were significantly higher in the Group P(p=0.001,0.01,0.003,and 0.003,respectively).However,GGOs with irregular borders and single consolidations were more significant among the Group PP(p=0.01 and 0.003,respectively).Of note,reticular distortions and subpleural spares were exclusively detected in the Group PP.Conclusion:We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients.The clinical signs and symptoms are not always useful either.The presence of multiple unilateral GGOs,diffused GGOs,and multiple bilateral consolidations favor COVID-19 with 88%,97.62%,and 77.7%diagnostic accuracy.