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National risk factors for blunt cardiac injury: Hemopneumothorax is the strongest predictor
Areg Grigorian1, Jeffrey Milliken1, Joshua K Livingston1
1University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
Insights
Sternal fracture is more strongly linked to blunt cardiac injury than thoracic aortic injury after chest trauma. Hemopneumothorax, however, is the most significant predictor of blunt cardiac injury.
Area of Science:
- Trauma Surgery
- Cardiology
- Emergency Medicine
Background:
- Blunt cardiac injury (BCI) can result from chest trauma, sometimes co-occurring with sternal fracture (SF).
- Thoracic aortic injury (TAI) involves significant force transmission to the thorax, raising questions about its association with BCI.
Purpose of the Study:
- To investigate the association between sternal fracture (SF) and thoracic aortic injury (TAI) with blunt cardiac injury (BCI).
- To identify the strongest predictors of BCI in adult blunt trauma patients.
Main Methods:
- Utilized the National Trauma Data Bank (NTDB) from 2007-2015.
- Analyzed data from adult patients who sustained blunt trauma.
Main Results:
- BCI occurred in 0.3% of patients (15,976).
- Sternal fracture (SF) showed a stronger association with BCI (OR=5.52) than thoracic aortic injury (TAI) (OR=4.82).
- Hemopneumothorax emerged as the strongest independent predictor of BCI (OR=9.53), followed by SF and esophageal injury (OR=5.47).
Conclusions:
- Sternal fracture is more strongly associated with BCI than TAI following blunt trauma.
- Hemopneumothorax is the most potent predictor of BCI.
- Recommend screening for BCI in patients with high-risk features like hemopneumothorax, SF, esophageal injury, and TAI after blunt chest trauma.
Background:
Blunt cardiac injury (BCI) can occur after chest trauma and may be associated with sternal fracture (SF). We hypothesized that injuries demonstrating a higher transmission of force to the thorax, such as thoracic aortic injury (TAI), would have a higher association with BCI.
Methods:
We queried the National Trauma Data Bank (NTDB) from 2007-2015 to identify adult blunt trauma patients.
Results:
BCI occurred in 15,976 patients (0.3%). SF had a higher association with BCI (OR = 5.52, CI = 5.32-5.73, p < 0.001) compared to TAI (OR = 4.82, CI = 4.50-5.17, p < 0.001). However, the strongest independent predictor was hemopneumothorax (OR = 9.53, CI = 7.80-11.65, p < 0.001) followed by SF and esophageal injury (OR = 5.47, CI = 4.05-7.40, p < 0.001).
Conclusion:
SF after blunt trauma is more strongly associated with BCI compared to TAI. However, hemopneumothorax is the strongest predictor of BCI. We propose all patients presenting after blunt chest trauma with high-risk features including hemopneumothorax, sternal fracture, esophagus injury, and TAI be screened for BCI.
Summary:
Using the National Trauma Data Bank, sternal fracture is more strongly associated with blunt cardiac injury than blunt thoracic aortic injury. However, hemopneumothorax was the strongest predictor.
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