Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury

George C. Velmahos, Marios Karaiskakis, Ali Salim, Konstantinos G. Toutouzas, James Murray, Juan A. Asensio, Demetrios Demetriades, Ronald J. Simon, Michael L. Hawkins, Samir Fakhry, Turner M. Osier

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

Background: Uncertainty about the definition and diagnosis of blunt cardiac injury (BCI) leads to unnecessary hospitalization and cost while trying to rule it out. The purpose of this study was to examine whether the combination of two simple tests, electrocardiography (ECG) and serum troponin I (TnI) level, may serve as reliable predictors of BCI or the absence of it. Methods: Over a period of 30 months (September 1999-February 2002), 333 consecutive patients with significant blunt thoracic trauma were followed prospectively. Serial ECG and TnI tests were performed routinely and echocardiography was performed selectively. Clinically significant BCI (SigBCI) was defined as the presence of cardiogenic shock, arrhythmias requiring treatment, or posttraumatic structural deficits. Results: SigBCI was diagnosed in 44 patients (13%). Of 80 patients with abnormal ECG and TnI, 27 (34%) developed SigBCI. Of 131 with normal serial ECG and TnI, none developed Sig-BCI. Of patients with abnormal ECG only or TnI only, 22% and 7%, respectively, developed SigBCI. The positive and negative predictive values were 29% and 98% for ECG, 21% and 94% for TnI, and 34% and 100% for the combination of ECG and TnI. The admission ECG or TnI was abnormal in 43 of 44 patients with SigBCI. Only one patient had initially normal ECG and TnI and developed abnormalities 8 hours after admission. Forty-one patients without other significant injuries stayed 1 to 3 days in the hospital only to rule out SigBCI and could have been discharged earlier. Besides ECG and TnI, other independent risk factors of SigBCI were an Injury Severity Score > 15, the presence of significant skeletal trauma, and history of cardiac disease. Conclusion: The combination of normal ECG and TnI at admission and 8 hours later rules out the diagnosis of SigBCI. In the absence of other reasons for hospitalization, such patients can be safely discharged.

Original languageEnglish
Pages (from-to)45-51
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume54
Issue number1
DOIs
StatePublished - Jan 1 2003
Externally publishedYes

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Troponin I
Electrocardiography
Serum
Wounds and Injuries
Hospitalization
Myocardial Contusions
Injury Severity Score
Cardiogenic Shock
Uncertainty
Echocardiography
Cardiac Arrhythmias
Heart Diseases
Thorax

All Science Journal Classification (ASJC) codes

  • Surgery

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Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. / Velmahos, George C.; Karaiskakis, Marios; Salim, Ali; Toutouzas, Konstantinos G.; Murray, James; Asensio, Juan A.; Demetriades, Demetrios; Simon, Ronald J.; Hawkins, Michael L.; Fakhry, Samir; Osier, Turner M.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 54, No. 1, 01.01.2003, p. 45-51.

Research output: Contribution to journalArticle

Velmahos, GC, Karaiskakis, M, Salim, A, Toutouzas, KG, Murray, J, Asensio, JA, Demetriades, D, Simon, RJ, Hawkins, ML, Fakhry, S & Osier, TM 2003, 'Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury', Journal of Trauma - Injury, Infection and Critical Care, vol. 54, no. 1, pp. 45-51. https://doi.org/10.1097/00005373-200301000-00006
Velmahos, George C. ; Karaiskakis, Marios ; Salim, Ali ; Toutouzas, Konstantinos G. ; Murray, James ; Asensio, Juan A. ; Demetriades, Demetrios ; Simon, Ronald J. ; Hawkins, Michael L. ; Fakhry, Samir ; Osier, Turner M. / Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. In: Journal of Trauma - Injury, Infection and Critical Care. 2003 ; Vol. 54, No. 1. pp. 45-51.
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abstract = "Background: Uncertainty about the definition and diagnosis of blunt cardiac injury (BCI) leads to unnecessary hospitalization and cost while trying to rule it out. The purpose of this study was to examine whether the combination of two simple tests, electrocardiography (ECG) and serum troponin I (TnI) level, may serve as reliable predictors of BCI or the absence of it. Methods: Over a period of 30 months (September 1999-February 2002), 333 consecutive patients with significant blunt thoracic trauma were followed prospectively. Serial ECG and TnI tests were performed routinely and echocardiography was performed selectively. Clinically significant BCI (SigBCI) was defined as the presence of cardiogenic shock, arrhythmias requiring treatment, or posttraumatic structural deficits. Results: SigBCI was diagnosed in 44 patients (13{\%}). Of 80 patients with abnormal ECG and TnI, 27 (34{\%}) developed SigBCI. Of 131 with normal serial ECG and TnI, none developed Sig-BCI. Of patients with abnormal ECG only or TnI only, 22{\%} and 7{\%}, respectively, developed SigBCI. The positive and negative predictive values were 29{\%} and 98{\%} for ECG, 21{\%} and 94{\%} for TnI, and 34{\%} and 100{\%} for the combination of ECG and TnI. The admission ECG or TnI was abnormal in 43 of 44 patients with SigBCI. Only one patient had initially normal ECG and TnI and developed abnormalities 8 hours after admission. Forty-one patients without other significant injuries stayed 1 to 3 days in the hospital only to rule out SigBCI and could have been discharged earlier. Besides ECG and TnI, other independent risk factors of SigBCI were an Injury Severity Score > 15, the presence of significant skeletal trauma, and history of cardiac disease. Conclusion: The combination of normal ECG and TnI at admission and 8 hours later rules out the diagnosis of SigBCI. In the absence of other reasons for hospitalization, such patients can be safely discharged.",
author = "Velmahos, {George C.} and Marios Karaiskakis and Ali Salim and Toutouzas, {Konstantinos G.} and James Murray and Asensio, {Juan A.} and Demetrios Demetriades and Simon, {Ronald J.} and Hawkins, {Michael L.} and Samir Fakhry and Osier, {Turner M.}",
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T1 - Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury

AU - Velmahos, George C.

AU - Karaiskakis, Marios

AU - Salim, Ali

AU - Toutouzas, Konstantinos G.

AU - Murray, James

AU - Asensio, Juan A.

AU - Demetriades, Demetrios

AU - Simon, Ronald J.

AU - Hawkins, Michael L.

AU - Fakhry, Samir

AU - Osier, Turner M.

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N2 - Background: Uncertainty about the definition and diagnosis of blunt cardiac injury (BCI) leads to unnecessary hospitalization and cost while trying to rule it out. The purpose of this study was to examine whether the combination of two simple tests, electrocardiography (ECG) and serum troponin I (TnI) level, may serve as reliable predictors of BCI or the absence of it. Methods: Over a period of 30 months (September 1999-February 2002), 333 consecutive patients with significant blunt thoracic trauma were followed prospectively. Serial ECG and TnI tests were performed routinely and echocardiography was performed selectively. Clinically significant BCI (SigBCI) was defined as the presence of cardiogenic shock, arrhythmias requiring treatment, or posttraumatic structural deficits. Results: SigBCI was diagnosed in 44 patients (13%). Of 80 patients with abnormal ECG and TnI, 27 (34%) developed SigBCI. Of 131 with normal serial ECG and TnI, none developed Sig-BCI. Of patients with abnormal ECG only or TnI only, 22% and 7%, respectively, developed SigBCI. The positive and negative predictive values were 29% and 98% for ECG, 21% and 94% for TnI, and 34% and 100% for the combination of ECG and TnI. The admission ECG or TnI was abnormal in 43 of 44 patients with SigBCI. Only one patient had initially normal ECG and TnI and developed abnormalities 8 hours after admission. Forty-one patients without other significant injuries stayed 1 to 3 days in the hospital only to rule out SigBCI and could have been discharged earlier. Besides ECG and TnI, other independent risk factors of SigBCI were an Injury Severity Score > 15, the presence of significant skeletal trauma, and history of cardiac disease. Conclusion: The combination of normal ECG and TnI at admission and 8 hours later rules out the diagnosis of SigBCI. In the absence of other reasons for hospitalization, such patients can be safely discharged.

AB - Background: Uncertainty about the definition and diagnosis of blunt cardiac injury (BCI) leads to unnecessary hospitalization and cost while trying to rule it out. The purpose of this study was to examine whether the combination of two simple tests, electrocardiography (ECG) and serum troponin I (TnI) level, may serve as reliable predictors of BCI or the absence of it. Methods: Over a period of 30 months (September 1999-February 2002), 333 consecutive patients with significant blunt thoracic trauma were followed prospectively. Serial ECG and TnI tests were performed routinely and echocardiography was performed selectively. Clinically significant BCI (SigBCI) was defined as the presence of cardiogenic shock, arrhythmias requiring treatment, or posttraumatic structural deficits. Results: SigBCI was diagnosed in 44 patients (13%). Of 80 patients with abnormal ECG and TnI, 27 (34%) developed SigBCI. Of 131 with normal serial ECG and TnI, none developed Sig-BCI. Of patients with abnormal ECG only or TnI only, 22% and 7%, respectively, developed SigBCI. The positive and negative predictive values were 29% and 98% for ECG, 21% and 94% for TnI, and 34% and 100% for the combination of ECG and TnI. The admission ECG or TnI was abnormal in 43 of 44 patients with SigBCI. Only one patient had initially normal ECG and TnI and developed abnormalities 8 hours after admission. Forty-one patients without other significant injuries stayed 1 to 3 days in the hospital only to rule out SigBCI and could have been discharged earlier. Besides ECG and TnI, other independent risk factors of SigBCI were an Injury Severity Score > 15, the presence of significant skeletal trauma, and history of cardiac disease. Conclusion: The combination of normal ECG and TnI at admission and 8 hours later rules out the diagnosis of SigBCI. In the absence of other reasons for hospitalization, such patients can be safely discharged.

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