TOPLINE:

In a US study, the median time for emergency pericardiocentesis was 38 minutes for penetrating trauma vs 78 minutes for blunt trauma. Additionally, the diagnosis of cardiac injury in penetrating trauma reduced from 55% to 27%, whereas rates in blunt trauma remained stable between 2011 and 2022.

METHODOLOGY:

• Researchers conducted a nationwide retrospective analysis of the National Trauma Data Bank from 2011 to 2022 and included 1036 patients (median age, 41 years; 76% men; 59% with blunt trauma and 41% with penetrating trauma) who underwent pericardiocentesis in the emergency department (ED) within 48 hours of hospital arrival and before cardiac repair surgery.
• Patients had a median Injury Severity Score of 24, and chronic comorbidities — such as congestive heart failure, diabetes, and chronic renal failure — were more prevalent in patients with blunt trauma.
• The primary outcomes were pericardiocentesis timing and the proportion of patients with significant cardiac injuries, defined using Abbreviated Injury Scale severity scores of 3, 5, or 6.
• The secondary outcomes were disposition after ED care, in-hospital mortality, hospital length of stay (LOS), ICU LOS, and complications.

TAKEAWAY:

• The median time to pericardiocentesis was 38 minutes for patients with penetrating trauma (approximately 70% received the procedure within 1 hour of hospital arrival) and 78 minutes for those with blunt trauma (approximately 30% underwent the procedure > 4 hours after arrival; P < .001). Significant cardiac injury was more common in patients with penetrating trauma than in those with blunt trauma (38.7% vs 12.4%).
• Overall, 78.5% of patients with penetrating trauma vs 34.2% of patients with blunt trauma proceeded to the operating room (P < .001), and ICU admission rates were 6.9% vs 26.1%. Hospital LOS did not differ significantly, but ICU LOS was longer for patients with blunt trauma (P < .001).
• Mortality rates were lower in patients with penetrating trauma than in those with blunt trauma (12.2% vs 25.5%; P < .001). Patients with penetrating trauma also had lower rates of cardiac arrests than those with blunt trauma (13.7% vs 23.7%; P < .001).
• Cardiac injury diagnoses declined significantly in patients with penetrating trauma (55% to 27%; P for trend < .001), whereas no significant change was observed in patients with blunt trauma.

IN PRACTICE:

"A significant downward trend in the proportion of penetrating trauma patients diagnosed with cardiac injuries following pericardiocentesis over the past decade reflects changing clinical practice patterns. In contrast, the indications for pericardiocentesis in blunt trauma remain less defined, highlighting the ongoing diagnostic challenges associated with blunt cardiac injury," the authors wrote. "These findings underscore the need to reassess trauma management protocols and ATLS® training to better align with contemporary clinical practice," they added.

SOURCE:

The study was led by Morihiro Katsura, MD, MPH, University of Southern California, Los Angeles. It was published online on August 29, 2025, in The American Journal of Emergency Medicine.

LIMITATIONS:

This study was limited by its retrospective registry design and the restricted imaging and procedural details, which may have affected clinical decision-making. Coding constraints during the transition from International Classification of Diseases 9 to 10 may have prevented the precise identification of related procedures. Additionally, the study lacked clarity on the clinical rationale and intent of pericardiocentesis and focused on pericardiocentesis use trends rather than summative clinical outcomes.

DISCLOSURES:

The authors did not report any funding sources or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.