Blunt cardiac injury in children
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Published on: March 17, 2020
D W Tellez1, W D Hardin, M Takahashi
1Division of Pediatric Surgery, Childrens Hospital of Los Angeles, CA 90027.
Insights
Continuous cardiac monitoring is recommended for children with blunt trauma injuries, rather than extensive cardiac evaluations. This approach helps identify transient arrhythmias and manage cardiac irritability effectively.
Area of Science:
- Pediatric Intensive Care
- Trauma Surgery
- Cardiology
Background:
- Children admitted to the pediatric intensive care unit (PICU) with blunt trauma often sustain multiple injuries.
- Assessing cardiac involvement in these pediatric trauma patients is crucial for appropriate management.
Purpose of the Study:
- To evaluate the necessity of comprehensive cardiac diagnostic studies in children with blunt trauma.
- To determine the incidence of cardiac injury (contusion and concussion) in pediatric blunt trauma patients.
Main Methods:
- Serial electrocardiograms (EKGs), creatinine phosphokinase (CPK) isoenzymes, echocardiography, and radionuclide angiography were performed on 39 pediatric blunt trauma patients.
- Patients were categorized based on injury severity (Modified Injury Severity Score [MISS]) and cardiac findings.
Main Results:
- 3 children (7.7%) had cardiac contusion, while 8 (20%) had cardiac concussion.
- 14 children (36%) showed isolated EKG or radionuclide angiography abnormalities.
- Two children required anti-arrhythmic therapy for significant dysrhythmias.
Conclusions:
- Comprehensive cardiac evaluation is not always justified for all pediatric blunt trauma patients.
- Continuous cardiac monitoring from the emergency room through PICU stay is essential for detecting transient dysrhythmias.
- Serial EKGs and cardiac isoenzyme assays are recommended for patients with significant dysrhythmias or thoracic injuries.
Abstract:
Thirty-nine children admitted to the pediatric intensive care unit with multiple injuries from blunt trauma underwent serial EKGs, determination of creatinine phosphokinase (CPK) isoenzymes, echocardiography, and radionuclide angiography studies. Motor vehicle injuries were responsible for 83% (32 of 39) of admissions, the remainder (7 of 39) caused by falls from heights. Thirteen children sustained serious (Modified Injury Severity Score [MISS] greater than 25) multiple system injury. Chest injuries were sustained by 12 children, nine being serious thoracic injuries (MISS chest score greater than 2). Three children (7.7%) showed elevations of MB fraction of CPK isoenzymes in addition to EKG abnormalities and/or ejection fraction depression on radionuclide angiography and were considered to have sustained cardiac contusion. Eight other children (20%) had normal or borderline elevation of CPK-MB fraction and EKG abnormalities combined with abnormal echocardiograms or radionuclide angiograms, and were considered to have sustained cardiac concussion. An additional 14 children (36%) had EKG or radionuclide angiography abnormalities alone. Two children required lidocaine therapy for cardiac irritability manifesting as multifocal PVCs and ventricular tachycardia. Based on this study, a comprehensive diagnostic evaluation of the heart in all children sustaining multiple injuries from blunt trauma cannot be justified. Continuous cardiac monitoring should be initiated in the emergency room and maintained throughout intensive care unit confinement to identify transient dysrhythmias. In patients with significant dysrhythmias and in those with obvious thoracic injuries serial EKG and cardiac isoenzyme assay should be obtained. Dysrhythmias should be man-aged with appropriate anti-arrhythmic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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