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Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury.
J Trauma. 2003 Jan; 54(1):45-50; discussion 50-1.JT

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 SigBCI. 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.

Authors+Show Affiliations

Velmahos GC
Department of Surgery, University of Southern California, and the Los Angeles County and University of Southern California (LAC+USC) Medical Center, Los Angeles, CA 90033, USA. velmahos@usc.edu.
Karaiskakis M
No affiliation info available
Salim A
No affiliation info available
Toutouzas KG
No affiliation info available
Murray J
No affiliation info available
Asensio J
No affiliation info available
Demetriades D
No affiliation info available

MeSH

AdultBiomarkersEchocardiographyElectrocardiographyFemaleHeart InjuriesHospital MortalityHumansInjury Severity ScoreLength of StayLos AngelesMaleMiddle AgedPredictive Value of TestsProspective StudiesRisk FactorsSurvival AnalysisTime FactorsTrauma CentersTriageTroponin IWounds, Nonpenetrating

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

12544898

Citation

Velmahos, George C., et al. "Normal Electrocardiography and Serum Troponin I Levels Preclude the Presence of Clinically Significant Blunt Cardiac Injury." The Journal of Trauma, vol. 54, no. 1, 2003, pp. 45-50; discussion 50-1.
Velmahos GC, Karaiskakis M, Salim A, et al. Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. J Trauma. 2003;54(1):45-50; discussion 50-1.
Velmahos, G. C., Karaiskakis, M., Salim, A., Toutouzas, K. G., Murray, J., Asensio, J., & Demetriades, D. (2003). Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. The Journal of Trauma, 54(1), 45-50; discussion 50-1.
Velmahos GC, et al. Normal Electrocardiography and Serum Troponin I Levels Preclude the Presence of Clinically Significant Blunt Cardiac Injury. J Trauma. 2003;54(1):45-50; discussion 50-1. PubMed PMID: 12544898.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR 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, AU - Demetriades,Demetrios, PY - 2003/1/25/pubmed PY - 2003/2/8/medline PY - 2003/1/25/entrez SP - 45-50; discussion 50-1 JF - The Journal of trauma JO - J Trauma VL - 54 IS - 1 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 SigBCI. 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. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/12544898/Normal_electrocardiography_and_serum_troponin_I_levels_preclude_the_presence_of_clinically_significant_blunt_cardiac_injury_ DB - PRIME DP - Unbound Medicine ER -