Pattern, characterization and outcomes of blunt and penetrating cardiothoracic injuries. A medico-legal comparative study

Abstract

Cardiothoracic injuries are crucial aspect of traumatology, resulting in significant morbidities and mortalities. Little is understood about the interrelationship between mechanism of trauma, and the associated outcomes. This work aimed to investigate the association between the mechanism of trauma and the induced pattern of injuries, as well as their association with adverse outcomes, namely mortality and the need for mechanical ventilation (MV). The current study is a prospective cohort study involving 229 patients diagnosed with acute cardiothoracic injuries. This work reveals an overall mortality of 22.3%, while 42.4% needed MV. Exsanguination was the leading cause of death, followed by respiratory failure. Cardiac, great vessels, and other mediastinal injuries, as well as diaphragmatic injuries, were significantly higher in penetrating trauma. Though blunt trauma was primarily unintentional, they are graver and more lethal than penetrating ones, denoted by significantly higher injury severity score, need for MV (49.6% vs. 32.3%), and mortality (28.6% vs. 13.5%). Cardiac injuries significantly predicted death and MV (P < 0.05). Other significant mutual predictors of mortality and MV were blunt trauma, diaphragmatic injuries, hemothorax and hemopericardium, facial and intracranial injuries (subdural hemorrhage), and clavicular fractures. Two proposed models explained 74.6% and 60.5% of variances in probability of mortality and MV, respectively. Those models demonstrated high accuracy, above 89.21%. The proven association between the mechanism of trauma and pattern of injuries, as well as the need for MV and death, warrants precise interpretation and rapid response in various settings to improve outcomes for patients affected with cardiothoracic trauma.