ANATOMICCardiac Wound Index
Awaiting Findings
Select the cardiac chamber location and the patient's physiologic state to determine the injury index.
Guidelines & Evidence
Verified
Last Review: 2026
When to Use
When to Use
Any confirmed or suspected penetrating cardiac injury — gunshot wound (GSW), stab wound, or impalement to the precordium, thorax, epigastrium, or axilla
Intraoperative grading at time of emergency department thoracotomy (EDT) or operating room (OR) sternotomy/thoracotomy for cardiac wound characterization
Postoperative documentation for trauma registry, quality improvement (QI), and outcomes benchmarking
Research stratification — enables comparison of operative outcomes across institutions using standardized severity language
Prognosis communication — guides early goals-of-care discussion in critical presentations (Index IV–V)
Blunt cardiac injury with structural disruption (chamber rupture) — less common but classifiable using the same framework
Mechanism of Injury Context
| Mechanism | Frequency of Cardiac Injury | Predominant Chamber | Survival to OR |
|---|---|---|---|
| Stab wound (SW) | Most survivable; tamponade common | RV (most anterior) > LV | 60–80% if vital signs present on arrival |
| Gunshot wound (GSW) | Higher energy; multi-chamber common | RV > LV; septal involvement frequent | 20–40% if vital signs present on arrival |
| Shotgun wound | Highly destructive; multi-structure | Often involves multiple chambers + great vessels | <15% survival to OR |
| Impalement | Mechanism-dependent; often tamponade | Variable by trajectory | 40–70% if object in situ (tamponades wound) |
| Blunt (MVA/crush) | Rare rupture; contusion more common | RA/RV free wall; atrial appendage | <20% survival for free wall rupture |
Comparison with Related Cardiac Trauma Tools
| Tool | Scope | Basis | Primary Use | Relation to Cardiac Wound Index |
|---|---|---|---|---|
| Cardiac Wound Index (Buckman) | Penetrating cardiac injury | Anatomic + physiologic | Operative grading, outcome prediction | Reference tool for this entry |
| AAST Cardiac OIS (Grade I–V) | Penetrating + blunt cardiac | Anatomic severity only | Registry coding, universal trauma language | Complementary; AAST is anatomy-only, CWI adds physiology |
| Revised Trauma Score (RTS) | All trauma | Physiologic (GCS, SBP, RR) | Prehospital triage, TRISS input | Combined with anatomic grade in TRISS; does not specify cardiac anatomy |
| Shock Index (SI) | All trauma hemorrhagic shock | Physiologic (HR/SBP) | Rapid bedside hemodynamic triage | Elevated SI (>1.0) correlates with Index IV–V cardiac wounds |
| FAST Exam | Pericardial effusion detection | Imaging (ultrasound) | Bedside cardiac tamponade screening | Guides urgency of operative intervention; precedes grading |
Explicit Limitations
The Cardiac Wound Index is assigned intraoperatively or at autopsy — it cannot be determined from imaging or clinical examination alone. It does not account for injury to the coronary arteries, great vessels, or cardiac valves independently; these require supplementary documentation. The Index was derived primarily from penetrating injury cohorts at urban US trauma centers and may not generalize to rural settings, blunt mechanisms, or pediatric populations. It should not replace surgeon gestalt in operative decision-making.
Exclusion Criteria
Blunt cardiac contusion without structural injury — myocardial contusion graded separately (AAST Cardiac OIS Grade I–II)
Isolated great vessel injury (aorta, pulmonary artery) without direct chamber involvement — use AAST Thoracic Vascular OIS
Pericardial injury without cardiac chamber involvement (AAST Cardiac OIS Grade I)
Iatrogenic cardiac perforation (procedural complication) — not a traumatic injury; managed under different clinical frameworks
Last Comprehensive Review: 2026