title: Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline.
abstract: BACKGROUND
  Diagnosing blunt cardiac injury (BCI) can be difficult. Many patients with mechanism for BCI are admitted to the critical care setting based on associated injuries; however, debate surrounds those patients who are hemodynamically stable and do not otherwise require a higher level of care. To allow safe discharge home or admission to a nonmonitored setting, BCI should be definitively ruled out in those at risk.
  
  
  METHODS
  This Eastern Association for the Surgery of Trauma (EAST) practice management guideline (PMG) updates the original from 1998. English-language citations were queried for BCI from March 1997 through December 2011, using the PubMed Entrez interface. Of 599 articles identified, prospective or retrospective studies examining BCI were selected. Each article was reviewed by two members of the EAST BCI PMG workgroup. Data were collated, and a consensus was obtained for the recommendations.
  
  
  RESULTS
  We identified 35 institutional studies evaluating the diagnosis of adult patients with suspected BCI. This PMG has 10 total recommendations, including two Level 2 updates, two upgrades from Level 3 to Level 2, and three new recommendations.
  
  
  CONCLUSIONS
  Electrocardiogram (ECG) alone is not sufficient to rule out BCI. Based on four studies showing that the addition of troponin I to ECG improved the negative predictive value to 100%, we recommend obtaining an admission ECG and troponin I from all patients in whom BCI is suspected. BCI can be ruled out only if both ECG result and troponin I level are normal, a significant change from the previous guideline. Patients with new ECG changes and/or elevated troponin I should be admitted for monitoring. Echocardiogram is not beneficial as a screening tool for BCI and should be reserved for patients with hypotension and/or arrhythmias. The presence of a sternal fracture alone does not predict BCI. Cardiac computed tomography or magnetic resonance imaging can be used to differentiate acute myocardial infarction from BCI in trauma patients.
authors.affiliation: Department of Surgery, York Hospital Trauma Program, York, Pennsylvania 17405, USA. kdclancy@yahoo.com
authors.forename: Keith
authors.initials: K
authors.lastname: Clancy
authors.forename: Catherine
authors.initials: C
authors.lastname: Velopulos
authors.forename: Jaroslaw W
authors.initials: JW
authors.lastname: Bilaniuk
authors.forename: Bryan
authors.initials: B
authors.lastname: Collier
authors.forename: William
authors.initials: W
authors.lastname: Crowley
authors.forename: Stanley
authors.initials: S
authors.lastname: Kurek
authors.forename: Felix
authors.initials: F
authors.lastname: Lui
authors.forename: Donna
authors.initials: D
authors.lastname: Nayduch
authors.forename: Ayodele
authors.initials: A
authors.lastname: Sangosanya
authors.forename: Brian
authors.initials: B
authors.lastname: Tucker
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
mesh_terms: D004562:Electrocardiography; D006335:Heart Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed; D019210:Troponin I / Q000097:blood; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D019210:Troponin I