title: Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury.
abstract: BACKGROUND
  Blunt cardiac injury (BCI) is an infrequent but potentially fatal finding in thoracic trauma. Its clinical presentation is highly variable and patient characteristics and injury pattern have never been described in trauma patients. The aim of this study was to identify predictors of mortality in BCI patients.
  
  
  METHODS
  We performed an 8-year retrospective analysis of all trauma patients diagnosed with BCI at our Level 1 trauma center. Patients older than 18 years, blunt chest trauma, and a suspected diagnosis of BCI were included. BCI was diagnosed based on the presence of electrocardiography (EKG), echocardiography, biochemical cardiac markers, and/or radionuclide imaging studies. Elevated troponin I was defined as more than 2 recordings of greater than or equal to .2. Abnormal EKG findings were defined as the presence of bundle branch block, ST segment, and t-wave abnormalities. Univariate and multivariate regression analyses were performed.
  
  
  RESULTS
  A total of 117 patients with BCI were identified. The mean age was 51 ± 22 years, 65% were male, mean systolic blood pressure was 93 ± 65, and overall mortality rate was 44%. Patients who died were more likely to have a lactate greater than 2.5 (68% vs 31%, P = .02), hypotension (systolic blood pressure < 90) (86% vs 14%, P = .001), and elevated troponin I (86% vs 11%, P = .01). There was no difference in the rib fracture (58% vs 56%, P = .8), sternal fracture (11% vs 21%, P = .2), and abnormal EKG (89% vs 90%, P = .6) findings. Hypotension and lactate greater than 2.5 were the strongest predictors of mortality in BCI.
  
  
  CONCLUSIONS
  BCI remains an important diagnostic and management challenge. However, once diagnosed resuscitative therapy focused on correction of hypotension and lactate may prove beneficial. Although the role of troponin in diagnosing BCI remains controversial, elevated troponin may have prognostic significance.
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA. Electronic address: bjoseph@surgery.arizona.edu.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Tahereh O
authors.initials: TO
authors.lastname: Jokar
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khalil
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Ansab A
authors.initials: AA
authors.lastname: Haider
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Zeeshan
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Daniyal
authors.initials: D
authors.lastname: Abbas
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D064847:Multimodal Imaging / Q000379:methods; D000071956:Myocardial Contusions / Q000175:diagnosis* / Q000401:mortality*; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014193:Trauma Centers; D019210:Troponin I / Q000032:analysis; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000401:mortality*
chemical_list: D019210:Troponin I
keywords: Blunt cardiac injury; Cardiac contusion; Predictors of mortality