Cardiac injury-trauma grading
Cardiac injuries are graded I-VI with increasing severity having higher grading (e.g. grade VI injuries are not salvageable).
- Blunt cardiac trauma with minor ECG abnormalities such as nonspecific ST or T wave changes, premature atrial or ventricular contraction or persistent sinus tachycardia
- Blunt or penetrating pericardial wound with no cardiac injury, tamponade or herniation
- Blunt cardiac trauma with ECG abnormalities of heart block or ischemic changes, but NO cardiac failure
- Penetrating tangential cardiac wound (not deep enough to extend through endocardium; and without tamponade)
- Blunt cardiac injury with ECG abnormalities of sustained or multifocal ventricular contractions
- Blunt or penetrating cardiac injury with NO cardiac failure and any of the following:
- Distal coronary artery occlusion
- Papillary muscle dysfunction
- Pulmonic incompetence
- Septal rupture
- Tricuspid incompetence
- Blunt pericardial laceration with cardiac herniation
- Blunt cardiac injury with cardiac failure
- Penetrating tangential myocardial wound (not deep enough to extend through endocardium; but with presence of tamponade)
- Blunt or penetrating cardiac injury WITH cardiac failure and any of the following:
- Distal coronary artery occlusion
- Papillary muscle dysfunction
- Pulmonic incompetence
- Septal rupture
- Tricuspid incompetence
- Blunt or penetrating cardiac injury with aortic or mitral incompetence
- Blunt or penetrating cardiac injury of the right ventricle, or either atrium
- Blunt or penetrating cardiac injury with proximal coronary artery occlusion
- Blunt or penetrating injury with left ventricular perforation
- Stellate injuries <50% tissue loss of the right ventricle, or either atrium
- Blunt avulsion of the heart
- Penetrating wound producing >50% tissue loss of a chamber
Note that the grading is increased by one grade for multiple penetrating wounds to a single chamber or multiple chamber involvement.
Moore EE, et al. Organ injury scaling IV: thoracic vascular, lung, cardiac and diaphragm. J Trauma. 1994;36:229. Trauma scoring. Trauma.org. Available at http://www.trauma.org/archive/scores/ois-heart.html (Accessed 23 April 2008)