Comparison of the effectiveness of pericardiocentesis and surgical pericardiotomy in the prognosis of patients with blunt traumatic cardiac tamponade: a multicenter study using the Japan Trauma Data Bank. Issue 1 (20th June 2022)

• Record Type: Journal Article
• Authors: Omoto, Kenichiro; Tanaka, Chie; Fukuda, Reo; Tagami, Takashi; Unemoto, Kyoko
• Is Part Of: Acute medicine & surgery. Volume 9:Issue 1(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-06-20
• Subjects: Blunt trauma -- cardiac tamponade -- percutaneous pericardiocentesis -- pericardial drainage -- surgical pericardiotomy; Surgery -- Periodicals; Medical emergencies -- Periodicals; 617.005
• DOI: 10.1002/ams2.768
• Languages: English
• ISSNs: 2052-8817

Abstract

Abstract : Aim: To compare the prognostic impact of pericardiocentesis (PCC) and surgical pericardiotomy (SP) in blunt traumatic pericardial tamponade. Methods: Among 361, 706 trauma patients registered in the Japan Trauma Data Bank from January 2004 to December 2018, we included those with blunt traumatic cardiac tamponade who underwent PCC and/or SP. We excluded patients with penetrating trauma, age younger than 15 years, Injury Severity Score (ISS) equal to 75, blood pressure 0 mmHg at the time of admission, head Abbreviated Injury Scale (AIS) score 5 or more, and those with missing data for outcomes. To examine the effect of SP, patients were divided into a PCC group and an SP‐only group. Missing values of age, sex, systolic blood pressure, respiratory rate, pulse rate, time from emergency call to hospital arrival, head AIS, chest AIS, abdomen/pelvis AIS, Glasgow Coma Scale score, and ISS were estimated using multiple imputation. In‐hospital mortality was analyzed using multivariable analysis, and we undertook a survival analysis. Results: We analyzed 305 patients, 150 (49.2%) in the PCC group and 155 (50.8%) in the SP‐only group. The in‐hospital mortality rate was 40.7% in the PCC group and 76.8% in the SP‐only group. Multivariable analysis after multiple imputation showed an odds ratio of SP for in‐hospital mortality 5.34 (95% confidence interval, 2.80–10.18; P < 0.01) compared with PCC. Using the Kaplan–Meier method, SP showed a significant risk of mortality (hazard ratio 2.16; 95% confidence interval, 1.58–2.95; P < 0.01). Conclusions: In patients with blunt traumatic cardiac tamponade, SP was associated with poor prognosis. Abstract : Logistic regression analysis for risk of mortality, adjusted for pericardial drainage method and other confounding factors