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Early detection of myocardial contusion and its complications in patients with blunt trauma
M J Norton1, G G Stanford, J A Weigelt
1Department of Surgery, University of Texas Southwestern Medical School, Parkland Memorial Hospital, Dallas 75235-9031.
Insights
Identifying patients with myocardial contusion early is crucial. An abnormal electrocardiogram (ECG) and Injury Severity Score (ISS) greater than 10 can predict this cardiac injury, reducing unnecessary monitoring.
Area of Science:
- Emergency Medicine
- Cardiology
- Trauma Care
Background:
- Myocardial contusion diagnosis is challenging, leading to overuse of critical care resources.
- Identifying high-risk patients upon admission can optimize resource allocation.
Purpose of the Study:
- To define predictive factors for myocardial contusion in emergency department patients.
- To identify patients who may not require extensive cardiac monitoring.
Main Methods:
- Retrospective study of 88 patients with suspected myocardial contusion.
- Analysis of patient history, physical findings, ECG, creatine kinase-MB, Injury Severity Score (ISS), and echocardiography.
- Multivariate analysis to identify predictive factors for myocardial contusion.
Main Results:
- 27 patients (31%) were diagnosed with myocardial contusion.
- Abnormal admission ECG and ISS ≥ 10 were significant predictors (p<0.05).
- Absence of both predictors indicated a 1% probability of myocardial contusion.
Conclusions:
- An abnormal ECG and ISS ≥ 10 effectively identify high-risk patients for myocardial contusion.
- These easily obtainable variables can guide decisions on cardiac monitoring in the emergency department.
- Further prospective studies are needed to validate these findings.
Abstract:
Myocardial contusion remains an elusive clinical entity, which consumes a disproportionate amount of scarce and expensive critical care resources for the purpose of cardiac monitoring. This study attempts to define a group of patients at high risk who can be identified from the available data present at the time of admission. All patients admitted with the suspicion of a myocardial contusion over a 3-year period were retrospectively studied. The records were examined for history, physical findings, electrocardiographic (ECG) results, creatine kinase levels, Injury Severity Score (ISS), and echocardiographic findings. A diagnosis of a myocardial contusion was made if patients had an ECG consistent with acute injury, increased creatine kinase-MB, or an abnormal echocardiogram consistent with acute injury. Patients were stratified into two groups: Group 1 patients satisfied the criteria for a myocardial contusion and Group 2 patients lacked sufficient evidence to substantiate this diagnosis. The records were then examined for the presence of factors available in the emergency room that might be predictive of a myocardial contusion or its complications. A total of 88 patients were evaluated; 27 of these were found to have a myocardial contusion (Group 1) with 61 patients placed in Group 2 (no myocardial contusion). Group 1 patients had an abnormal admission ECG (p less than 0.05), and an ISS greater than or equal to 10 (p less than 0.05). Multivariate analysis identified two factors predictive of a myocardial contusion: an abnormal ECG and an ISS greater than 10. When these two predictors were absent, the probability of a myocardial contusion was 1%. No predictors of a complication of a myocardial contusion were identified. These data suggest that a combination of easily obtained variables in the emergency department can be used to select a patient population at high risk for myocardial contusion. Prospective evaluation of these variables is necessary.