Clinically significant blunt cardiac trauma: Role of serum troponin levelscombined with electrocardiographic findings

Background: The true importance of blunt cardiac trauma (BCT) Is related to the cardiac complications arising from it. Diagnostic tests that can predi ct accurately if such complications will develop or not may allow early and aggressive monitoring or early discharge. We investigated the role of two simple and convenient tests, serum cardiac troponin I (cTnI) and electrocar diogram (ECG), when used to identify patients at risk of cardiac complicati ons after BCT. Methods: Over a 10-month period, 115 patients with evidence of significant blunt thoracic trauma were prospectively followed to identify the presence of clinically significant BCT (Sig-BCT), defined as cardiogenic shock, arrh ythmias requiring treatment, or structural cardiac abnormalities directly r elated to the cardiac trauma. An ECG was obtained at admission and at 8 hou rs. Cardiac troponin I was measured at admission, at 4 hours, and at 8 hour s. Transthoracic echocardiography was performed when clinically indicated, The sensitivity, specificity, and positive and negative predictive values o f ECG and cTnI to identify Sig-BCT were calculated, Clinical risk factors f or Sig-BCT were examined by univariate and multivariate analysis. Results: Nineteen patients (16.5%) were diagnosed with Sig-BCT and, in 18 o f them, symptoms presented within 24 hours of admission. Abnormal electroca rdiographic findings were detected in 58 patients (50%) and elevated cTnI l evels in 27 (23.5%), Electrocardiography and cTnI had positive predictive v alues of 28% and 48% and negative predictive values of 95% and 93%, respect ively. However, when both tests were abnormal (positive) or normal (negativ e), the positive and negative predictive values increased to 62% and 100%, respectively. Other independent risk factors for Sig-BCT were head injury, spinal injury, history of preexisting cardiac disease, and a chest Abbrevia ted Injury Score greater than 2. Conclusion: The combination of ECG and cTnI identifies reliably the presenc e or absence of Sig-BCT, Patients with an abnormal ECG and cTnI need close monitoring for at least 24 hours. Patients with a normal admission ECG and cTnI can be safely discharged in the absence of other injuries.