Penetrating cardiac injures: A 36-year perspective at an urban, level I trauma center.

Background: This study evaluates patterns of injuries and outcomes from penetrating cardiac injuries (PCI) at Grady Memorial Hospital, an urban, level I trauma center in Atlanta, Georgia, over 36 years. Methods: Patients sustaining PCIs were identified from The Trauma Registry of the American College of Surgeons and the Emory Department of Surgery database; patients who expired prior to any therapy were excluded. Demographics and outcomes were compared over three time intervals: Period 1 (1975-1985; n=113), Period 2 (1986-1996; n=79), and Period 3 (2000-2010; n=79). Results: 271 patients (86% male, mean age = 33 years, initial base deficit = -11.3 mEq/L) sustained cardiac stab (SW, 60%) or gunshot wounds (GSW, 40%). Emergency department thoracotomy was performed in 67/271 (25%) patients. Overall mortality increased in the modern era (Period 1, 27% vs. Period 2, 22% vs. Period 3, 42%, p=0.03) along with GSW mechanisms (Period 1, 32% vs. Period 2, 33% vs. Period 3, 57%, p=0.001), GSW mortality (Period 1, 36% vs. Period 2, 42% vs. Period 3, 56%, p=0.04), and multi-chamber injuries (Period 1, 12% vs. Period 2, 10% vs. Period 3, 34%, p

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