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Suspected myocardial contusion. Triage and indications for monitoring
D H Wisner1, W H Reed, R S Riddick
1Department of Surgery, University of California, Davis School of Medicine, California.
Insights
Diagnosing myocardial contusion after blunt trauma is challenging. This study found clinically significant contusions are rare, and patients with serious complications can be identified in the emergency room.
Area of Science:
- Emergency Medicine
- Cardiology
- Trauma Surgery
Background:
- Myocardial contusion diagnosis is unclear, complicating patient management and bed allocation.
- Blunt cardiac injury sequelae require careful evaluation to determine appropriate monitoring levels.
Purpose of the Study:
- To clarify the clinical implications of myocardial contusion diagnoses.
- To identify reliable methods for predicting serious complications in blunt trauma patients.
Main Methods:
- Retrospective review of 3010 blunt trauma patients over 16 months.
- Analysis of outcomes for patients admitted to monitored versus unmonitored beds.
- Evaluation of diagnostic tests including electrocardiogram, echocardiography, and creatine phosphokinase isoenzyme levels.
Main Results:
- No serious arrhythmias or heart failure occurred in 2204 patients admitted to unmonitored beds.
- Clinically significant myocardial contusions were rare, with only four arrhythmias requiring treatment among 95 evaluated patients.
- Admission electrocardiogram conduction abnormalities predicted serious arrhythmias, while echocardiography and enzyme levels did not predict morbidity.
Conclusions:
- Clinically significant myocardial contusions are uncommon in blunt trauma patients.
- Patients at risk for life-threatening complications from blunt cardiac injury can be identified in the emergency department.
- Admission electrocardiogram findings are valuable in predicting arrhythmias following blunt chest trauma.
Abstract:
Although many different tests are used to diagnose myocardial contusion, the clinical implications of the diagnosis are unclear. This makes it difficult to decide which patients require admission to a monitored bed. During 16 months, 3010 patients with blunt trauma were reviewed for evidence of sequelae attributable to myocardial contusion. None of 2204 admissions to unmonitored beds had evidence of serious arrhythmias or heart failure. No patient who died after admission had myocardial contusion at autopsy. Of the 644 admissions to monitored beds, 95 had workups for suspected contusion. Heart failure not obvious on admission did not occur and there were only four arrhythmias that required treatment. Conduction abnormalities on admission electrocardiogram predicted serious arrhythmias. Echocardiography and creatine phosphokinase isoenzyme levels, although frequently positive, did not predict morbidity. Clinically significant myocardial contusions are rare. Patients who will develop life-threatening complications from blunt cardiac injury can be identified in an emergency room setting.