Selective monitoring of patients with suspected blunt cardiac injury

Blunt chest trauma can result in cardiac injury with consequent dysrhythmias, valve malfunction, or frank rupture. Typically, patients with blunt chest trauma and suspected cardiac injury have required cardiac monitoring for 48 to 72 hours. Predicting which patients with blunt chest trauma are not at risk for cardiac complications would obviate many patient-hours of monitoring in the intensive care unit. This series examines the sensitivity of two-dimensional surface echocardiography in predicting cardiac complications. Over a 24-month period, 115 patients were admitted with blunt chest trauma and prospectively evaluated for cardiac injury with admission electrocardiograms, serial creatine kinase isoenzyme studies, and two-dimensional echocardiography. Thirty-one patients (27%) had abnormal two-dimensional echocardiograms. In 8 (25.8%) of these patients, cardiac complications requiring treatment developed. Eighty-four patients (73%) had normal two-dimensional echocardiograms, and a cardiac complication requiring treatment developed in only 1 (1.2%) of them. Of the 9 patients who required treatment of cardiac complications, 3 had normal admission electrocardiograms and only 1 had elevated levels of the myocardial-specific isoenzymes of creatine kinase. We believe two-dimensional echocardiography is a sensitive test for evaluating cardiac injury resulting from blunt chest trauma and is helpful in selecting those patients who require monitoring in the intensive care unit.