title: The asymptomatic patient with suspected myocardial contusion.
abstract: Diagnostic criteria and guidelines for hospital admission for suspected myocardial contusion (MCC) remain unclear. This study defines and examines the clinical sequelae of patients admitted with a suspicion of MCC. Criteria for observation following isolated, minor blunt chest trauma are suggested. Hospital and trauma registry records of patients admitted over a 33-month period with suspected MCC were reviewed. Conventional evaluation criteria, cardiac-related complications, and associated injuries were analyzed for 524 patients. Twenty-eight cardiac-related complications occurred in 27 of 524 patients (5%). These complications included 23 dysrhythmias, 3 infarctions, and 2 pericardial effusions. There were 23 patients with abnormal admission electrocardiograms and 4 with normal ones. Of the latter, one patient developed dysrhythmia 4 hours after admission, and three had other major multi-system injuries requiring admission to the intensive care unit. The overall incidence of cardiac-related complications in minimally injured patients was 0.1%. There were no complications in patients with isolated chest wall contusions, a normal admission electrocardiogram, and a normal rhythm at 4 hours. There was no significant association between creatine phosphokinase isoenzymes or echocardiogram and cardiac-related complications. The complete absence of significant cardiac sequelae in patients with isolated chest wall contusion, normal admission and 4-hour electrocardiograms, and no other associated major injuries suggests that these patients need not be admitted.
authors: Department of Surgery, University of California, San Diego Medical Center.
authors: M B
authors: MB
authors: Foil
authors: R C
authors: RC
authors: Mackersie
authors: S R
authors: SR
authors: Furst
authors: J W
authors: JW
authors: Davis
authors: M S
authors: MS
authors: Swanson
authors: D B
authors: DB
authors: Hoyt
authors: S R
authors: SR
authors: Shackford
mesh_terms: D000328:Adult; D003288:Contusions / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D007527:Isoenzymes; D008297:Male; D012307:Risk Factors; D013898:Thoracic Injuries / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications*
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase