Cardiac troponin T as a biochemical marker of myocardial injury early after trauma. Diagnostic value of a qualitative bedside

Introduction: To evaluate within a trauma population the diagnostic value o f a qualitative test (TROPT(R) Rapid Assay) for the specific detection of c irculating cardiac troponin T (cTnT) in comparison with the traditionally u sed CK/CK-MB ratio especially in the early in-hospital phase. Methods: Pros pective study in trauma patients over a 12-month period. Multifacetted diag nostic approach to myocardial cell injury based on quantitative as well as qualitative cTnT and CK-MB/CK measurements, electrocardiographic (ECG) and echocardiographic (TTE) findings. Setting: A regional trauma centre, the Fe deral Armed Forces Medical Centre Ulm, Germany. Subjects: One hundred and t wenty-five patients with major blunt trauma admitted to the Federal Armed F orces Medical Centre Ulm between October 1995 and November 1996. Results: T he TROPT(R) Rapid Assay results significantly correlated with the results o f the quantitative cTnT determinations (P < 0.001; sensitivity 1.0 and 0.86 /specificity 0.96 and 0.94 upon hospital admission and completion of diagno stic procedures). There was no significant correlation between CK-MB/CK rat io and quantitative cTnT findings. Upon hospital admission all patients who se quantitative cTnT measurement showed a positive test result (greater tha n or equal to 0.2 mu g/l) also had a positive TROPT(R) Rapid Assay result ( negative prediction value 1.0). There was a significant correlation of TROP T(R) Rapid Assay results and the diagnosis of a concomitant "chest trauma" (P < 0.002). While a significant correlation between the TROPT(R) Rapid Ass ay results and specific ECG changes was observed (P < 0.008), the findings relating to CK-MB/CK ratio did not show any significant relation to specifi c ECG or specific TTE changes. A significant correlation between TROPT(R) R apid Assay results and myocardial lesion related specific therapeutic inter ventions was observed (P < 0.01; specificity 1.0, sensitivity 0.11). Conclu sions: Within a multifacetted diagnostic approach to blunt cardiac trauma, cTnT should replace CK-MB as the biochemical marker of choice. The TROPT(R) Rapid Assay is a test which rapidly and accurately enables the trauma team to differentiate patients with and without myocardial cell injury. It does not efficiently identify trauma patients at risk for the development of ca rdiac complications.