Determining which patients require evaluation for blunt cardiac injury following blunt chest trauma

The objective of this study was to determine prospectively which risk facto rs require cardiac monitoring for blunt cardiac injury (BCI) following blun t chest trauma. All patients who sustained blunt chest trauma had an electr ocardiogram (ECG) on admission to our urban level I trauma center. Those wi th ST segment changes, dysrhythmias, hemo-dynamic instability, history of c ardiac disease, age >55 years, or a need for general anesthesia within 24 h ours (group 1) were admitted to the intensive care unit (ICU) for 24 hours where they were subjected to serial ECGs, creatinine phosphokinase (CPK) as says, and echocardiography (ECHO). Those with only mechanism for BCI, i.e., none of the above risk factors (group 2), were admitted to a nonmonitored bed and had a follow-up ECG 24 hours later. A series of 315 patients were a dmitted with blunt chest trauma during a 17-month period; 144 patients mere in group 1 and 171 in group 2. Overall, 22 patients were diagnosed as BCI (+BCI), defined as evolving ST segment changes, dysrhythmias, a CPK-MB inde x of >2.5, or hemodynamic instability. Of the 18 +BCI patients in group 1, all were symptomatic (i.e., none was included solely for a cardiac history, age, or need for general anesthesia). Six of these patients required treat ment for dysrhythmias, hypotension, or pulmonary edema; one of whom died. F our patients with +BCI were in group 2 and had ECG changes at 24 hours; non e of these four had any sequelae from their +BCI. None of the ECHOs demonst rated abnormal wall motion. Patients who sustain blunt chest trauma with a normal EGG, normal blood pressure, and no dysrhythmias on admission require no further intervention for BCI. Patients with ST segment changes, dysrhyt hmias, or hypotension following blunt chest trauma should be monitored for 24 hours, as this sub-group occasionally requires further treatment for com plications of BCI. ECHO adds nothing as a screening test.