Elevated Cardiac Troponin I Level in Cases of Thoracic Nonaccidental Trauma

Abstract

Injury patterns in nonaccidental trauma (NAT) often include injury to the chest. However, signs and symptoms of cardiac insult are often nonspecific and may be missed. Evaluation with serum cardiac troponin I (CTnI), a specific indicator of myocardial injury, could improve the comprehensive evaluation of patients with suspected NAT. The objective of this study was to describe the patient characteristics and results of CTnI testing in children with thoracic NAT. Children presenting to the emergency department were included if CTnI was obtained and they had at least one of the following: history of blunt trauma to the chest, bruising or abrasions to the chest, or fractures of the ribs, sternum, or clavicles. A serum CTnI level above 0.04 ng/mL was considered elevated. Ten patients (6 males) with an age range from 2 months to 4 years (mean [SD], 20 [20] months) were identified during the 17-month study period. All patients were evaluated with NAT. Cardiac troponin I level was elevated in 7 (70%) of 10 patients with levels between 2 and 50 times the upper limit of normal. This report is the first to document elevation of CTnI levels in cases of thoracic NAT. The elevation of the level of this specific biomarker may be indicative of sufficient chest trauma to result in the heart being injured, independent of the presence of cardiac decompensation or shock from other causes. Prospective evaluation of the forensic and clinical use of CTnI in this population is warranted.