Clinically significant blunt cardiac trauma

Role of serum troponin levels combined with electrocardiographic findings

Ali Salim, George C. Velmahos, Anurag Jindal, Linda Chan, Pantelis Vassiliu, Howard Belzberg, Juan A. Asensio, Demetrios Demetriades

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Background: The true importance of blunt cardiac trauma (BCT) is related to the cardiac complications arising from it. Diagnostic tests that can predict accurately if such complications will develop or not may allow early and aggressive monitoring or early discharge. We investigated the role of two simple and convenient tests, serum cardiac troponin I (cTnI) and electrocardiogram (ECG), when used to identify patients at risk of cardiac complications after BCT. Methods: Over a 10-month period, 115 patients with evidence of significant blunt thoracic trauma were prospectively followed to identify the presence of clinically significant BCT (Sig-BCT), defined as cardiogenic shock, arrhythmias requiring treatment, or structural cardiac abnormalities directly related to the cardiac trauma. An ECG was obtained at admission and at 8 hours. Cardiac troponin I was measured at admission, at 4 hours, and at 8 hours. Transthoracic echocardiography was performed when clinically indicated. The sensitivity, specificity, and positive and negative predictive values of ECG and cTnI to identify Sig-BCT were calculated. Clinical risk factors for Sig-BCT were examined by univariate and multivariate analysis. Results: Nineteen patients (16.5%) were diagnosed with Sig-BCT and, in 18 of them, symptoms presented within 24 hours of admission. Abnormal electrocardiographic findings were detected in 58 patients (50%) and elevated cTnI levels in 27 (23.5%). Electrocardiography and cTnI had positive predictive values of 28% and 48% and negative predictive values of 95% and 93%, respectively. However, when both tests were abnormal (positive) or normal (negative), the positive and negative predictive values increased to 62% and 100%, respectively. Other independent risk factors for Sig-BCT were head injury, spinal injury, history of preexisting cardiac disease, and a chest Abbreviated Injury Score greater than 2. Conclusion: The combination of ECG and cTnI identifies reliably the presence or absence of Sig-BCT. Patients with an abnormal ECG and cTnI need close monitoring for at least 24 hours. Patients with a normal admission ECG and cTnI can be safely discharged in the absence of other injuries.

Original languageEnglish
Pages (from-to)237-243
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume50
Issue number2
StatePublished - 2001
Externally publishedYes

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Troponin
Troponin I
Electrocardiography
Wounds and Injuries
Serum
Spinal Injuries
Thoracic Injuries
Preexisting Condition Coverage
Cardiogenic Shock
Craniocerebral Trauma
Routine Diagnostic Tests
Echocardiography
Cardiac Arrhythmias
Heart Diseases
Thorax
Multivariate Analysis
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Salim, A., Velmahos, G. C., Jindal, A., Chan, L., Vassiliu, P., Belzberg, H., ... Demetriades, D. (2001). Clinically significant blunt cardiac trauma: Role of serum troponin levels combined with electrocardiographic findings. Journal of Trauma - Injury, Infection and Critical Care, 50(2), 237-243.

Clinically significant blunt cardiac trauma : Role of serum troponin levels combined with electrocardiographic findings. / Salim, Ali; Velmahos, George C.; Jindal, Anurag; Chan, Linda; Vassiliu, Pantelis; Belzberg, Howard; Asensio, Juan A.; Demetriades, Demetrios.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 50, No. 2, 2001, p. 237-243.

Research output: Contribution to journalArticle

Salim, A, Velmahos, GC, Jindal, A, Chan, L, Vassiliu, P, Belzberg, H, Asensio, JA & Demetriades, D 2001, 'Clinically significant blunt cardiac trauma: Role of serum troponin levels combined with electrocardiographic findings', Journal of Trauma - Injury, Infection and Critical Care, vol. 50, no. 2, pp. 237-243.
Salim, Ali ; Velmahos, George C. ; Jindal, Anurag ; Chan, Linda ; Vassiliu, Pantelis ; Belzberg, Howard ; Asensio, Juan A. ; Demetriades, Demetrios. / Clinically significant blunt cardiac trauma : Role of serum troponin levels combined with electrocardiographic findings. In: Journal of Trauma - Injury, Infection and Critical Care. 2001 ; Vol. 50, No. 2. pp. 237-243.
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abstract = "Background: The true importance of blunt cardiac trauma (BCT) is related to the cardiac complications arising from it. Diagnostic tests that can predict accurately if such complications will develop or not may allow early and aggressive monitoring or early discharge. We investigated the role of two simple and convenient tests, serum cardiac troponin I (cTnI) and electrocardiogram (ECG), when used to identify patients at risk of cardiac complications after BCT. Methods: Over a 10-month period, 115 patients with evidence of significant blunt thoracic trauma were prospectively followed to identify the presence of clinically significant BCT (Sig-BCT), defined as cardiogenic shock, arrhythmias requiring treatment, or structural cardiac abnormalities directly related to the cardiac trauma. An ECG was obtained at admission and at 8 hours. Cardiac troponin I was measured at admission, at 4 hours, and at 8 hours. Transthoracic echocardiography was performed when clinically indicated. The sensitivity, specificity, and positive and negative predictive values of ECG and cTnI to identify Sig-BCT were calculated. Clinical risk factors for Sig-BCT were examined by univariate and multivariate analysis. Results: Nineteen patients (16.5{\%}) were diagnosed with Sig-BCT and, in 18 of them, symptoms presented within 24 hours of admission. Abnormal electrocardiographic findings were detected in 58 patients (50{\%}) and elevated cTnI levels in 27 (23.5{\%}). Electrocardiography and cTnI had positive predictive values of 28{\%} and 48{\%} and negative predictive values of 95{\%} and 93{\%}, respectively. However, when both tests were abnormal (positive) or normal (negative), the positive and negative predictive values increased to 62{\%} and 100{\%}, respectively. Other independent risk factors for Sig-BCT were head injury, spinal injury, history of preexisting cardiac disease, and a chest Abbreviated Injury Score greater than 2. Conclusion: The combination of ECG and cTnI identifies reliably the presence or absence of Sig-BCT. Patients with an abnormal ECG and cTnI need close monitoring for at least 24 hours. Patients with a normal admission ECG and cTnI can be safely discharged in the absence of other injuries.",
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AU - Belzberg, Howard

AU - Asensio, Juan A.

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N2 - Background: The true importance of blunt cardiac trauma (BCT) is related to the cardiac complications arising from it. Diagnostic tests that can predict accurately if such complications will develop or not may allow early and aggressive monitoring or early discharge. We investigated the role of two simple and convenient tests, serum cardiac troponin I (cTnI) and electrocardiogram (ECG), when used to identify patients at risk of cardiac complications after BCT. Methods: Over a 10-month period, 115 patients with evidence of significant blunt thoracic trauma were prospectively followed to identify the presence of clinically significant BCT (Sig-BCT), defined as cardiogenic shock, arrhythmias requiring treatment, or structural cardiac abnormalities directly related to the cardiac trauma. An ECG was obtained at admission and at 8 hours. Cardiac troponin I was measured at admission, at 4 hours, and at 8 hours. Transthoracic echocardiography was performed when clinically indicated. The sensitivity, specificity, and positive and negative predictive values of ECG and cTnI to identify Sig-BCT were calculated. Clinical risk factors for Sig-BCT were examined by univariate and multivariate analysis. Results: Nineteen patients (16.5%) were diagnosed with Sig-BCT and, in 18 of them, symptoms presented within 24 hours of admission. Abnormal electrocardiographic findings were detected in 58 patients (50%) and elevated cTnI levels in 27 (23.5%). Electrocardiography and cTnI had positive predictive values of 28% and 48% and negative predictive values of 95% and 93%, respectively. However, when both tests were abnormal (positive) or normal (negative), the positive and negative predictive values increased to 62% and 100%, respectively. Other independent risk factors for Sig-BCT were head injury, spinal injury, history of preexisting cardiac disease, and a chest Abbreviated Injury Score greater than 2. Conclusion: The combination of ECG and cTnI identifies reliably the presence or absence of Sig-BCT. Patients with an abnormal ECG and cTnI need close monitoring for at least 24 hours. Patients with a normal admission ECG and cTnI can be safely discharged in the absence of other injuries.

AB - Background: The true importance of blunt cardiac trauma (BCT) is related to the cardiac complications arising from it. Diagnostic tests that can predict accurately if such complications will develop or not may allow early and aggressive monitoring or early discharge. We investigated the role of two simple and convenient tests, serum cardiac troponin I (cTnI) and electrocardiogram (ECG), when used to identify patients at risk of cardiac complications after BCT. Methods: Over a 10-month period, 115 patients with evidence of significant blunt thoracic trauma were prospectively followed to identify the presence of clinically significant BCT (Sig-BCT), defined as cardiogenic shock, arrhythmias requiring treatment, or structural cardiac abnormalities directly related to the cardiac trauma. An ECG was obtained at admission and at 8 hours. Cardiac troponin I was measured at admission, at 4 hours, and at 8 hours. Transthoracic echocardiography was performed when clinically indicated. The sensitivity, specificity, and positive and negative predictive values of ECG and cTnI to identify Sig-BCT were calculated. Clinical risk factors for Sig-BCT were examined by univariate and multivariate analysis. Results: Nineteen patients (16.5%) were diagnosed with Sig-BCT and, in 18 of them, symptoms presented within 24 hours of admission. Abnormal electrocardiographic findings were detected in 58 patients (50%) and elevated cTnI levels in 27 (23.5%). Electrocardiography and cTnI had positive predictive values of 28% and 48% and negative predictive values of 95% and 93%, respectively. However, when both tests were abnormal (positive) or normal (negative), the positive and negative predictive values increased to 62% and 100%, respectively. Other independent risk factors for Sig-BCT were head injury, spinal injury, history of preexisting cardiac disease, and a chest Abbreviated Injury Score greater than 2. Conclusion: The combination of ECG and cTnI identifies reliably the presence or absence of Sig-BCT. Patients with an abnormal ECG and cTnI need close monitoring for at least 24 hours. Patients with a normal admission ECG and cTnI can be safely discharged in the absence of other injuries.

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