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Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings.
J Trauma. 2001 Feb; 50(2):237-43.JT

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.

Authors+Show Affiliations

Salim A
Department of Surgery, Division of Trauma and Critical Care, Keck School of Medicine, LAC+USC Medical Center, 1200 N. State Street, Room 9900, Los Angeles, CA 90033, USA. asalim@usc.edu
Velmahos GC
No affiliation info available
Jindal A
No affiliation info available
Chan L
No affiliation info available
Vassiliu P
No affiliation info available
Belzberg H
No affiliation info available
Asensio J
No affiliation info available
Demetriades D
No affiliation info available

MeSH

ElectrocardiographyFemaleHeart InjuriesHumansMaleMiddle AgedPredictive Value of TestsProspective StudiesRisk FactorsSensitivity and SpecificityTroponinWounds, Nonpenetrating

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11242287

Citation

Salim, A, et al. "Clinically Significant Blunt Cardiac Trauma: Role of Serum Troponin Levels Combined With Electrocardiographic Findings." The Journal of Trauma, vol. 50, no. 2, 2001, pp. 237-43.
Salim A, Velmahos GC, Jindal A, et al. Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings. J Trauma. 2001;50(2):237-43.
Salim, A., Velmahos, G. C., Jindal, A., Chan, L., Vassiliu, P., Belzberg, H., Asensio, J., & Demetriades, D. (2001). Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings. The Journal of Trauma, 50(2), 237-43.
Salim A, et al. Clinically Significant Blunt Cardiac Trauma: Role of Serum Troponin Levels Combined With Electrocardiographic Findings. J Trauma. 2001;50(2):237-43. PubMed PMID: 11242287.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings. AU - Salim,A, AU - Velmahos,G C, AU - Jindal,A, AU - Chan,L, AU - Vassiliu,P, AU - Belzberg,H, AU - Asensio,J, AU - Demetriades,D, PY - 2001/3/10/pubmed PY - 2001/4/6/medline PY - 2001/3/10/entrez SP - 237 EP - 43 JF - The Journal of trauma JO - J Trauma VL - 50 IS - 2 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. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/11242287/Clinically_significant_blunt_cardiac_trauma:_role_of_serum_troponin_levels_combined_with_electrocardiographic_findings_ DB - PRIME DP - Unbound Medicine ER -