Cardiac enzymes are irrelevant in the patient with suspected myocardial contusion.
BACKGROUND
Myocardial contusion is commonly diagnosed following blunt chest trauma, and has potentially lethal complications. Cost-effective case management in patients with suspected myocardial contusion is confounded by the low incidence of complications and the lack of a reliable test to predict them. The clinical usefulness of elevated cardiac enzyme levels is controversial.


METHODS
We analyzed a 4-year experience of 359 patients with high-risk blunt chest trauma who were assessed using an established practice guideline. Our multivariate statistical model evaluated all of the early risk factors included in the guideline, specifically focusing on cardiac enzyme levels.


RESULTS
Myocardial contusion was diagnosed in 30% of patients, and complications (dysrhythmias and cardiogenic shock) occurred in 5%. In no case was cardiac enzyme elevation the sole predictor of a complication. The cost of routine cardiac enzyme assay was substantial.


CONCLUSIONS
Cardiac enzyme determinations have no useful role in the evaluation of patients with suspected myocardial contusion. They should be eliminated from current practice guidelines.
Biffl
W L
WL
Department of Surgery, Denver General Hospital, Colorado 80204-4507.
Moore
F A
FA
Moore
E E
EE
Sauaia
A
A
Read
R A
RA
Burch
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003288:Contusions / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006335:Heart Injuries / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic
D007527:Isoenzymes; D003402:Creatine Kinase