Characteristics, mechanisms, and medicolegal perspectives of fatal cardiothoracic injuries in a tertiary care center.

Abstract

This study aims to investigate the medicolegal aspects of cardiothoracic trauma, including injury patterns, mechanism of infliction, survival time, predictors, and mechanism of mortality. A prospective cohort study included 229 cardiothoracic traumatized patients admitted to the Emergency Departments, who were categorized into patients with fatal or nonfatal injuries. Males constituted more than seven times the females with a 22.3% mortality rate. Intentional, self-inflicted injuries, road traffic accidents (RTAs), and falls from height (FFH) were significantly associated with a higher mortality There was a significant association between mortality and the presence of abrasions, large subcutaneous hematomas, and myocardial, pericardial, and cardiac chamber injuries. Additionally, diaphragmatic injuries, hemothorax, hemopericardium, head injuries (except extradural hemorrhage), and liver injuries were significantly more prevalent in fatal cases (p < 0.05). The injury severity score was significantly higher in fatal than nonfatal injuries (75 versus 29). Hemorrhage and respiratory failure constituted the primary mechanisms of death in 81.8% of trauma induced by sharp weapons and 52.6% of victims involved in RTAs, respectively. Mechanism of death in FFH varied between hemorrhagic shock (55.3%), cerebral injury (35.3%), respiratory failure (17.6%), and spinal cord injury (11.8%). A proposed mortality predictive model including diaphragmatic injury, hemopericardium, self-inflicted injuries, clavicular fractures, hemothorax, subdural and subarachnoid hemorrhage, and facial injuries explained 75.1% of variances in the probability of mortality. This study provides physicians with more knowledge about the predictors of mortality in cardiothoracic traumatized patients, helping to identify high-risk patients, prevent trauma-related deaths, and solve any related medicolegal issues.