[Cardiac troponin T as a biochemical marker of myocardial injury early after trauma. Diagnostic value of a qualitative bedside test].
BACKGROUND
To evaluate within a trauma population the diagnostic value of a qualitative test (TROPT Rapid Assay) for the specific detection of circulating cardiac troponin T (cTnT) in comparison with the traditionally used CK/CK-MB ratio especially in the early in-hospital phase.


METHODS
Prospective study in trauma patients over a 12-month period. Multifaceted diagnostic approach to myocardial cell injury based on quantitative as well as qualitative cTnT and CK-MB/CK measurements, electrocardiographic (ECG) and echocardiographic (TTE) findings.


METHODS
A regional trauma centre, the Federal Armed Forces Medical Centre Ulm, Germany.


METHODS
One hundred and twenty-five patients with major blunt trauma admitted to the Federal Armed Forces Medical Centre Ulm between October 1995 and November 1996.


RESULTS
The TROPT Rapid Assay results significantly correlated with the results of the quantitative cTnT determinations (P < 0.001; sensitivity 1.0 and 0. 86/specificity 0.96 and 0.94 upon hospital admission and completion of diagnostic procedures). There was no significant correlation between CK-MB/CK ratio and quantitative cTnT findings. Upon hospital admission all patients whose quantitative cTnT measurement showed a positive test result (>/= 0.2 microg/l) also had a positive TROPT Rapid Assay result (negative prediction value 1.0). There was a significant correlation of TROPT Rapid Assay results and the diagnosis of a concomitant rising "chest trauma" (P < 0.002). While a significant correlation between the TROPT Rapid Assay results and specific ECG changes was observed (P < 0.008), the findings relating to CK-MB/CK ratio did not show any significant relation to specific ECG or specific TTE changes. A significant correlation between TROPT Rapid Assay results and myocardial lesion related specific therapeutic interventions was observed (P < 0.01; specificity 1.0, sensitivity 0.11).


CONCLUSIONS
Within a multifaceted diagnostic approach to blunt cardiac trauma, cTnT should replace CK-MB as the biochemical marker of choice. The TROPT Rapid Assay is a test which rapidly and accurately enables the trauma team to differentiate patients with and without myocardial cell injury. It does not efficiently identify trauma patients at risk for the development of cardiac complications.
Helm
M
M
Abteilung für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus, Ulm.
Hauke
J
J
Weiss
A
A
Lampl
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002648:Child; D003288:Contusions / Q000097:blood / Q000175:diagnosis*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006335:Heart Injuries / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D011933:Reagent Kits, Diagnostic; D020107:Troponin T
Troponin T als biochemischer Marker der Myokard-Kontusion in der Frühphase nach Trauma. Diagnostische Wertigkeit eines qualitativen bedside Schnelltests.