PEDIATRIC BLUNT CARDIAC INJURY - EPIDEMIOLOGY, CLINICAL-FEATURES, ANDDIAGNOSIS

Aim: The goal of this study was to describe the epidemiology, clinical presentation, diagnostic methods, and outcome in a large series of ch ildren with blunt cardiac injury (BCI). Methods: A multicenter retrosp ective review of all individuals less than 18 years of age diagnosed w ith a BCI from 1983 to 1993 was conducted. Cases included all those wi th a discharge diagnosis of myocardial contusion, concussion, ventricu lar disruption, or unspecified BCI. Results: A total of 184 cases of B CI were identified in 16 participating centers. The median age was 7.4 years, and 73% were male. Myocardial contusions accounted for 95% of the diagnoses. The leading mechanisms were motor vehicle crashes invol ving a pedestrian (39.7%) or passenger (31.0%). The majority (87%) had multiple system trauma, with a mean Injury Severity Score of 27.2 (SD +/- 14.4). Pulmonary contusions were present in 50.5% and rib fractur es in 23.0%. The most common diagnostic test performed was a 12-lead e lectrocardiogram (EKG) (82%), followed by a MB band of creatine phosph okinase (CPK-MB) (69%) and echocardiogram (65%). All three tests were performed in 50%. In these patients, agreement among various diagnosti c test pairs was fair (echocardiogram vs. EKG, kappa = 0.27) to poor ( echocardiogram vs, CPK-MB, kappa = -0.07 and EKG vs. CPK-MB, kappa = 0 .08). No hemodynamically stable patient who presented with a normal si nus rhythm subsequently developed a cardiac arrhythmia or cardiac fail ure. There were 25 deaths (13.6%), 3 of which were caused by acute pum p failure secondary to massive cardiac injury. The remainder died of h ead or abdominal injuries. Of the 159 (86.4%) patients surviving, 8 (5 % of survivors) had significant cardiac sequela, most commonly mitral or tricuspid insufficiency or ventricular septal defect. Conclusions: Pediatric BCI is usually diagnosed in the context of severe multiple s ystem trauma and is less commonly an isolated event. Because of the la ck of a standard, various diagnostic tests are used in the diagnosis o f BCI, and these tests rarely agree. In hospitalized pediatric patient s with BCI, unanticipated complications are rare. Significant sequela, although uncommon, do occur and follow-up of children with BCI should be ensured.