A rational screening and treatment strategy based on the electrocardiogram alone for suspected cardiac contusion

Illig, Karl A.; Swierzewski, Mark J.; Feliciano, David V.; Morton, John H.

doi:10.1016/0002-9610(91)90105-m

Cited by 58 publications

(30 citation statements)

References 38 publications

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“…32,35 Probably echocardiogram should not be obtained except when there is clinical deterioration. 30 Associated injuries were seen in 66% of patients. The most common associated injuries were rib fractures (72%) and lower limb fractures (50%), while head injuries were seen in 16.6% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…[30][31][32][33] Too many authorities agree that admission ECG has the best correlation with subsequent cardiac problems, [34][35][36] and that ECG is very sensitive but not specific for cardiac contusion. 30 All the patients with ECG abnormalities in this study were discharged from the hospital in good condition. This supports the idea that most patients who survive to reach the emergency department tend to do well from the cardiac point of view.…”

Section: Discussionmentioning

confidence: 99%

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Sternal Fracture – Regional Experience

Batouk

1996

Ann Saudi Med

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A retrospective analysis of 27 sternal fracture patients out of 267 patients with chest trauma was done in the period between March 1990March (9-1410 and April 1994April (11-1414 at Asir Central Hospital, giving an incidence of 10% in all chest trauma. There were 25 males and two females, giving a ratio of 12.5:1. The age range was 18-70, with a mean age of 37.5 years and a median age of 35 years. The mean hospital stay was 12.2 days, with a range of 3 to 53 days and a median of seven days. The mechanism of injury and the types of associated injuries are presented. Twentyeight percent of the sternal fracture patients had abnormal electrocardiogram. Echocardiogram was done on only eight patients (32%); two were abnormal. Ann Saudi Med 1996;16(3):285-290. A Batouk, Sternal Fracture -Regional Experience. 1996; 16(3): 285-290 In 1751, Du Verney reported an exceptional case of compound fracture of the sternum in a quarry man.1 In 1864, Gurlt cited a series of 22,616 fractures of all types; among them were only 22 cases of uncomplicated fracture of the sternum caused by indirect violence.2 Different mechanisms have been reported, among which are muscle contraction 3 and labor, 4 but the most frequent cause of sternal fracture is the forceful impact of the sternum against the steering column of an automobile after a rapid deceleration. 5,6 Seat belts have been blamed in many studies. 7-9The bone injury itself has generally been reported as being inconsequential. The degree of association of sternal fracture with other types of injury, such as myocardial, major thoracic, vascular and spinal, is, however, significant. 10-18Our objectives are to determine the incidence, morbidity and mortality of patients with fractures of the sternum, to identify specific features of the sternal fracture which may predict the outcome, and to identify the factors that affect the duration of hospital stay in patients with sternal fracture. MethodsAsir Central Hospital is a 450-bed hospital in Abha City, located in the southwestern region of Saudi Arabia. It is a tertiary hospital, Level II Trauma Center, with a catchment population of one million.Data were collected from the medical records of 267 patients with chest trauma between March 1990 (9-1410) and April 1994April (11-1414, of whom 27 patients had sternal fracture. These were analyzed with regard to demographics, area of sternal fracture, admission electrocardiographic (ECG) and echocardiographic changes, treatment modalities and outcome of treatment.ECG was classified as abnormal when there were arrhythmias, conduction defects, nonspecific ST segment or T-wave changes, evidence of anatomical specific ischemia, sinus tachycardia or any other abnormality interpreted by a cardiologist. Chi-squared, two-tailed, Fisher's exact and Mann-Whitney-Wilcoxon tests were used as tests of significance at a 5% level of significance. ResultsDuring the four-year study period, there were 267 patients who sustained chest trauma, among whom 27 were found to have sternal fracture, giving an ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sternal Fracture – Regional Experience

Batouk

1996

Ann Saudi Med

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“…Historically, creatine kinase (CK) with myocardial type B (MB) fractions was utilised in order to assist in the detection of BCI or patients at risk for serious sequelae. Illig et al [39] found that CK-MB analysis failed to predict complications secondary to BCI which was further confi rmed by Biffl et al [39,40]. Lactate dehydrogenase-1 (LDH-1) to total LDH ratio is raised in all the patients with myocardial death in 24 hours but LDH-1/LDH-2 ratio rises within 9 hours of myocardial insult [41,42].…”

Section: Cardiac Markersmentioning

confidence: 98%

“…Cardiac troponins are most specifi c amongst conventional markers as they differ from the skeletal isoform by a unique aminoterminal sequence of 31 amino acids never expressed by skeletal muscle [43]. Cardiac troponin-I has shown maximum sensitivity (23-100%) and specifi city (85-97%) in detecting clinically signifi cant BCI [34][35][36][37][38][39][40][41][42][43][44][45][46]. Velmahos et al [47] concluded that, 100% negative predictive value was reached on combining ECG with troponin-I at 8 hours.…”

Section: Cardiac Markersmentioning

confidence: 99%

Challenges in the diagnosis of blunt cardiac injuries

Agarwal

Chandra

2009

Indian J Surg

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“…The single, most valuable screening tool for BCI is the ECG [14][15][16]. Nagy et al has one of the most compelling prospective studies that determined patients sustaining blunt chest trauma that have a normal ECG, normal hemodynamics, and no dysrhythmias required no further intervention for CC [16].…”

Section: Ecgmentioning

confidence: 99%

Cardiac Contusions

Brewer

Zarzaur

2015

Curr Trauma Rep

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Cardiac contusion has been one of the most discussed topics in the trauma community. The discussions are centered around appropriate nomenclature, screening mechanisms, diagnostic modalities, and ultimately management principles. Controversy over nomenclature exists because cardiac contusion has been used to describe an array of injuries ranging from a transient arrhythmia to free rupture of the myocardial wall. The mainstays of screening have been electrocardiograms and cardiac isoenzymes. Although there is a substantial body of literature, few other screening or diagnostic modalities have been widely accepted. Echocardiography has gained favor as a confirmatory test and to determine presence or extinct of structural damage. Management has traditionally been supportive including volume repletion, correcting arrhythmias, and repairing structural damage. Recently, there has been some promising alternative treatments including transcatheter closure of ventricular septal defects, anti-inflammatory agents, and post-injury therapeutic hypothermia. Although screening and diagnostic mechanism have remained relatively unchanged, it appears that innovative management of severe cardiac contusions has gained some momentum over the recent years.

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A rational screening and treatment strategy based on the electrocardiogram alone for suspected cardiac contusion

Cited by 58 publications

References 38 publications

Sternal Fracture – Regional Experience

Sternal Fracture – Regional Experience

Challenges in the diagnosis of blunt cardiac injuries

Cardiac Contusions

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