Clinical significance of radionuclide angiographically-determined abnormalities following acute blunt chest trauma

Schamp, David J.; Plotnick, Gary D.; Croteau, David; Rosenbaum, Richard C.; Johnston, Gerald S.; Rodríguez, Aurelio

doi:10.1016/0002-8703(88)90624-2

Cited by 10 publications

(4 citation statements)

References 21 publications

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“…Non-specific changes are also seen in trauma patients, some caused by anaemia, hypoxia, electrolyte abnormality and sympathetic and parasympathetic tone. This is in accordance with many other studies [ 18 , 32 ]. ECG changes tend to reflect the activity of the left ventricle, as this is larger than the right ventricle and close to the sternum.…”

Section: Discussionsupporting

confidence: 94%

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Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis

Kyriazidis,

Jakob,

Vargas

et al. 2023

World J Emerg Surg

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Introduction The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains. Aim of the study To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician. Methods A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I2 and the QUADAS-2 tool was used to assess bias of the studies. Results This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4–36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8–98.2%) and sensitivity of 86.7% (range 40–99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832–7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries. Conclusion Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases.

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Section: Discussionsupporting

confidence: 94%

“…According to the latest literature, a right bundle branch block resembles a severely injured right ventricle. Other types of conduction abnormalities have also been reported in patients with cardiac contusion [ 16 , 24 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis

Kyriazidis,

Jakob,

Vargas

et al. 2023

World J Emerg Surg

View full text Add to dashboard Cite

show abstract

“…ECG may be normal following BCI or may show nonspecific abnormalities [6,[26][27][28][29]. One may ask why ECG anomalies occur in patients with thoracic trauma with no diagnosis of BCI in our study.…”

Section: Discussionmentioning

confidence: 84%

“…The only conduction defect in the early phase was RBBB. The right ventricle is more affected than the left ventricle in trauma patients due to its anterior position and close relation to sternum, and usually transient RBBB may occur [8,12,16,17,21,29]. However, ECG mainly represents the electrical activity of the left ventricle, due to its large mass [2].…”

Section: Discussionmentioning

confidence: 99%