Abstract
PurposeMyocardial contusion can be a life-threatening condition in patients who sustained blunt thoracic trauma. The diagnostic approach remains a subject of debate. The aim of this study was to determine the sensitivity and specificity of echocardiography, electrocardiography, troponins T and I (TnT and TnI), and creatine kinase muscle/brain (CK-MB) for identifying patients with a myocardial contusion following blunt thoracic trauma.MethodsSensitivity and specificity were first determined in a 10-year retrospective cohort study and second by a systematic literature review with meta-analysis.ResultsOf the 117 patients in the retrospective study, 44 (38%) were considered positive for myocardial contusion. Chest X-ray, chest CT scan, electrocardiograph, and echocardiography had poor sensitivity (< 15%) but good specificity (≥ 90%). Sensitivity to cardiac biomarkers measured at presentation ranged from 59% for TnT to 77% for hs-TnT, specificity ranged from 63% for CK-MB to 100% for TnT. The systematic literature review yielded 28 studies, with 14.5% out of 7242 patients reported as positive for myocardial contusion. The pooled sensitivity of electrocardiography, troponin I, and CK-MB was between 62 and 71%, versus only 45% for echocardiography and 38% for troponin T. The pooled specificity ranged from 63% for CK-MB to 85% for troponin T and 88% for echocardiography.ConclusionThe best diagnostic approach for myocardial contusion is a combination of electrocardiography and measurement of cardiac biomarkers. If abnormalities are found, telemonitoring is necessary for the early detection of life-threatening arrhythmias. Chest X-ray and CT scan may show other thoracic injuries but provide no information on myocardial contusion.
Highlights
Myocardial contusion describes a condition of bruising or hemorrhaging of the heart muscle caused by blunt thoracic trauma
After studying the electronic medical records, 494 patients were excluded: 378 patients had not been suspected for myocardial contusion, 57 had not sustained blunt thoracic trauma, 21 had a confirmed myocardial infarction, and for 38 patients, diagnostic or outcome data were not available
The remaining 117 patients were admitted with a suspicion of myocardial contusion
Summary
Myocardial contusion describes a condition of bruising or (microscopically small) hemorrhaging of the heart muscle caused by blunt thoracic trauma. In patients who have sustained blunt thoracic trauma, the prevalence of myocardial contusion ranges from 0 to 76%, depending on the diagnostic criteria used [1,2,3,4,5,6,7,8,9,10]. The heart is abruptly pressed to the dorsal side of the sternum causing a bruise on the anterior side (‘coup’). Depending on the amount of energy that needs and can be absorbed by the rib cage, the thoracic spine can hit the heart at the posterior side, resulting in a second bruise (‘contrecoup’). The distance between the sternum and spine will reduce further, resulting in septal or intracardiac structural injuries
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