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Blunt cardiac injury: a 10 year institutional review
M H van Wijngaarden1, R Karmy-Jones, M K Talwar
1Department of Surgery, University of Alberta Hospitals, Edmonton, Canada.
Insights
Blunt cardiac injuries are often not clinically significant. While some patients experience complications, diagnostic markers like CK-MB and ECG changes do not reliably predict outcomes or mortality in these cases.
Area of Science:
- Trauma Surgery
- Cardiology
- Emergency Medicine
Background:
- Blunt cardiac injury is a significant concern in trauma patients.
- Accurate diagnosis and prognosis are crucial for effective management.
Purpose of the Study:
- To review a decade of blunt cardiac injury cases.
- To evaluate the predictive value of diagnostic markers for patient outcomes.
Main Methods:
- Retrospective review of 70 blunt cardiac injury cases over 10 years.
- Analysis of diagnostic markers: CK-MB, ECG abnormalities, arrhythmias.
- Correlation of markers with cardiac complications, inotrope requirement, and mortality.
Main Results:
- CK-MB elevation and ECG abnormalities did not predict arrhythmias, complications, inotrope need, or mortality.
- Cardiac complications occurred in 26% of patients.
- Patients requiring inotropes had higher Injury Severity Scores (ISS) and mortality.
- Only 3 deaths were directly attributed to cardiac injury.
Conclusions:
- Myocardial contusion is often of minor clinical significance.
- Diagnostic markers lack predictive power for severe outcomes.
- Early transthoracic echocardiography is recommended for diagnosis.
Abstract:
A 10 year review of all blunt cardiac injuries (N = 70) at a single trauma institution was conducted. The majority of patients were diagnosed on the basis of elevated myocardial band fraction of creatine kinase (CK-MB), ST/T wave changes or arrhythmias. The presence of CK-MB elevation was not predictive of arrhythmias, cardiac complications, inotrope requirement, or mortality. The presence of ECG abnormalities or arrhythmias was also not predictive of inotrope requirement or mortality. Cardia complications requiring treatment occurred in 26 per cent (N = 18) of patients. Patients requiring inotropes (N = 12, 17 per cent) had higher Injury Severity Scores (ISS), longer times from injury to emergency, and higher mortality rates, than those not requiring them. Patients who died (N = 10) had a higher ISS, lower Revised Trauma Score, and a more frequent need for inotropes. Only three deaths were directly attributable to the cardiac injury. Myocardial contusion is an injury often of little clinical importance. Patients present with injuries of little or no consequence, severe injuries where the diagnosis is readily apparent, or as a confounding variable in a multiply injured patient. Early use of transthoracic echocardiography is advocated.