title: Assessment of cardiac injury in patients with blunt chest trauma.
abstract: BACKGROUND
  There has been difficulty in the appropriate determination of blunt cardiac injury (BCI) related to blunt thoracic trauma (BTT). The aim of this study is to assess BCI and the effectiveness of diagnostic tests in BTT in patients admitted to the emergency department (ED).
  
  
  METHODS
  Eighty-eight patients with suspected myocardial injury in BTT were enrolled. The diagnostic criteria for BCI were: elevation of troponin I, arrhythmia requiring treatment, unexplained low voltage on electrocardiography (ECG), unexplained hypotension requiring vasopressor, cardiogenic shock requiring inotropes, and transthoracic echocardiographic (TTE) findings suggestive of BCI. Patients with arrhythmia in the medical history, congestive heart failure, ischemic heart disease, history of cardiac surgery, and those <16 years of age were excluded.
  
  
  RESULTS
  The BCI rate was 25% in thoracic injuries. The sensitivity and specificity of troponin I, creatine kinase-MB fraction (CK-MB)/creatine kinase (CK) ratio, ECG, and CK-MB/CK ratio plus ECG were 68% and 100%, 50% and 53%, 54.5% and 72%, and 59% and 33%, respectively. Frequency of palpitation, initial CK-MB levels, initial heart rate, frequency of pulmonary contusion, abnormal ECG, and mortality rate were significantly higher in patients with BCI compared with patients without BCI. Pulmonary contusion, accompanying palpitation, Glasgow coma scale (GCS) ≤13, and abnormal ECG findings were important independent parameters increasing the likelihood of BCI on univariate analysis comparing patients with and without BCI.
  
  
  CONCLUSIONS
  Indicators such as cardiac enzymes and ECG have low sensitivity and specificity when used alone. The reliability of ECG in the diagnosis of BCI decreases in the later hours of trauma.
authors.affiliation: Department of Emergency Medicine, Ataturk University, School of Medicine, 25090, Erzurum, Turkey.
authors.forename: Mucahit
authors.initials: M
authors.lastname: Emet
authors.affiliation: Department of Emergency Medicine, Ataturk University, School of Medicine, 25090, Erzurum, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Akoz
authors.affiliation: Department of Emergency Medicine, Ataturk University, School of Medicine, 25090, Erzurum, Turkey. sahinaslan29@hotmail.com.
authors.forename: Sahin
authors.initials: S
authors.lastname: Aslan
authors.affiliation: Department of Emergency Medicine, Ataturk University, School of Medicine, 25090, Erzurum, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Saritas
authors.affiliation: Department of Emergency Medicine, Ataturk University, School of Medicine, 25090, Erzurum, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Cakir
authors.affiliation: Department of Medical Education, Ataturk University, School of Medicine, Erzurum, Turkey.
authors.forename: Hamit
authors.initials: H
authors.lastname: Acemoglu
keywords: Biomarker; Blunt injury; Diagnosis; Echocardiography; Electrocardiography; Myocardial injury; Thorax; Trauma; Troponin
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