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[Diagnostic value of CK-MB isoenzyme determinations in children with craniocerebral injuries and polytrauma]
Insights
Elevated creatine kinase-MB (CK-MB) in children with head injuries suggests myocardial damage, not necessarily heart contusion. CK-MB levels alone are unreliable for diagnosing heart contusion in pediatric head injury cases.
Area of Science:
- Pediatric Cardiology
- Trauma Medicine
- Biochemistry
Context:
- Acute head injury is common in children.
- Assessing cardiac injury in pediatric trauma is challenging.
- Creatine kinase (CK) and its isoenzyme CK-MB are cardiac biomarkers.
Purpose:
- To investigate the diagnostic utility of CK-MB for heart contusion in pediatric head injury.
- To determine the frequency of elevated CK-MB in children with head trauma.
- To correlate CK-MB levels with electrocardiogram (ECG) findings of heart contusion.
Summary:
- Total CK and CK-MB were measured in 71 children with varying degrees of head and chest trauma.
- Elevated CK-MB levels were observed frequently in children with isolated head injury, similar to those with chest trauma.
- No significant correlation was found between CK-MB levels and ECG features of heart contusion, indicating CK-MB is not a reliable diagnostic criterion for this condition.
Impact:
- CK-MB elevation in pediatric head injury may indicate myocardial damage due to sympathetic stimulation, not necessarily direct chest trauma.
- This study refutes the use of CK-MB as a sole diagnostic marker for heart contusion in pediatric head trauma.
- Findings suggest a need for alternative diagnostic approaches for cardiac injury in children with head trauma.
Abstract:
Total creatine kinase (CK) and its myocardial isoenzyme (CK-MB) were determined in 71 children with isolated acute head injury (N = 30), with head injury and polytrauma but without chesttrauma (N = 11) and with head injury and polytrauma including chest trauma (N = 30) on the second and third day after injury. Electrocardiograms were recorded in 56/71 children on each of the first three days in hospital. Elevations of CK-MB isoenzyme over 6% respectively over 10% of total CK are found as frequently in children with head injury without chest trauma as in children with head trauma and chest trauma. In addition there is no significant correlation between the level of the CK-MB and the incidence of ECG features characteristically associated with heart contusion. This study shows that the determination of CK-MB cannot be used as a criterion for diagnosing heart contusion in children with head injury. The finding of CK-MB in the serum of 53% children with isolated head injury exceeding 6% of total CK, and in the serum of 33% children exceeding 10% of total CK strongly suggests myocardial damage to be a frequent complication of cerebral damage with consecutive extreme sympathetic stimulation.