title: Blunt cardiac injury in critically ill trauma patients: a single centre experience.
abstract: OBJECTIVE
  This study describes the incidence and outcomes of blunt cardiac injury (BCI) in a single trauma intensive care unit (TICU), together with the spectrum of thoracic injuries and cardiac abnormalities seen in BCI.
  
  
  METHODS
  We performed a retrospective observational study of 169 patients with blunt thoracic trauma admitted from January 2010 to April 2013. BCI was diagnosed using an elevated serum troponin in the presence of either clinical, ECG or transthoracic echocardiography (TTE) abnormalities in keeping with BCI. The mechanism of injury, associated thoracic injuries and TTE findings in these patients are reported.
  
  
  RESULTS
  The incidence of BCI among patients with blunt thoracic trauma was 50% (n=84). BCI patients had higher injury severity scores (ISS) (median 37 [IQR 29-47]; p=0.001) and higher admission serum lactate levels (median 3.55 [IQR 2.4-6.2], p=0.008). In patients with BCI, the median serum TnI level was 2823ng/L (IQR 1353-6833), with the highest measurement of 64950ng/L. TTEs were performed on 38 (45%) patients with BCI, of whom 30 (79%) had abnormalities. Patients with BCI had a higher mortality (32% vs. 16%; p=0.028) and trended towards a longer length of stay (17.0 days [standard deviation (SD) 13.5] vs. 13.6 days [SD 12.0]; p=0.084).
  
  
  CONCLUSIONS
  BCI was associated with an increased mortality and a trend towards a longer length of stay in this study. It is a clinically relevant diagnosis which requires a high index of suspicion. Screening of high risk patients with significant blunt thoracic trauma for BCI with serum troponins should be routine practise. Patients diagnosed with BCI should undergo more advanced imaging such as TTE or TOE to exclude significant cardiac structural injury.
authors.affiliation: Department of Critical Care, King Edward VIII Hospital, P/Bag X02 Congella 4013, Durban, KwaZulu-Natal 4083, South Africa; Perioperative Research Group, Department of Anaesthetics & Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. Electronic address: drdavidskinner@gmail.com.
authors.forename: D L
authors.initials: DL
authors.lastname: Skinner
authors.affiliation: Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: G L
authors.initials: GL
authors.lastname: Laing
authors.affiliation: Perioperative Research Group, Department of Anaesthetics & Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R N
authors.initials: RN
authors.lastname: Rodseth
authors.affiliation: Perioperative Research Group, Department of Anaesthetics & Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Ryan
authors.affiliation: Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Level I Trauma Unit and Trauma Intensive Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
authors.forename: T C
authors.initials: TC
authors.lastname: Hardcastle
authors.affiliation: Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Level I Trauma Unit and Trauma Intensive Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
authors.forename: D J J
authors.initials: DJ
authors.lastname: Muckart
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003422:Critical Care; D016638:Critical Illness; D004562:Electrocardiography; D005260:Female; D006335:Heart Injuries / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D019344:Lactic Acid / Q000097:blood*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D019210:Troponin I / Q000097:blood*; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000175:diagnosis* / Q000401:mortality
chemical_list: D015415:Biomarkers; D019210:Troponin I; D019344:Lactic Acid
keywords: Blunt cardiac injury; Thoracic trauma