Identifying the broken heart

Predictors of mortality and morbidity in suspected blunt cardiac injury

Bellal Joseph, Tahereh O. Jokar, Mazhar Khalil, Ansab A. Haider, Narong Kulvatunyou, Bardiya Zangbar, Andrew Tang, Muhammad Zeeshan, Terence OKeeffe, Daniyal Abbas, Rifat Latifi, Peter Rhee

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)982-988
Number of pages7
JournalAmerican Journal of Surgery
Volume211
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Fingerprint

Morbidity
Mortality
Electrocardiography
Hypotension
Wounds and Injuries
Blood Pressure
Lactic Acid
Troponin
Troponin I
Thorax
Rib Fractures
Myocardial Contusions
Bundle-Branch Block
Trauma Centers
Radionuclide Imaging
Echocardiography
Multivariate Analysis
Biomarkers
Regression Analysis

Keywords

  • Blunt cardiac injury
  • Cardiac contusion
  • Predictors of mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Joseph, B., Jokar, T. O., Khalil, M., Haider, A. A., Kulvatunyou, N., Zangbar, B., ... Rhee, P. (2016). Identifying the broken heart: Predictors of mortality and morbidity in suspected blunt cardiac injury. American Journal of Surgery, 211(6), 982-988. https://doi.org/10.1016/j.amjsurg.2015.10.027

Identifying the broken heart : Predictors of mortality and morbidity in suspected blunt cardiac injury. / Joseph, Bellal; Jokar, Tahereh O.; Khalil, Mazhar; Haider, Ansab A.; Kulvatunyou, Narong; Zangbar, Bardiya; Tang, Andrew; Zeeshan, Muhammad; OKeeffe, Terence; Abbas, Daniyal; Latifi, Rifat; Rhee, Peter.

In: American Journal of Surgery, Vol. 211, No. 6, 01.06.2016, p. 982-988.

Research output: Contribution to journalArticle

Joseph, B, Jokar, TO, Khalil, M, Haider, AA, Kulvatunyou, N, Zangbar, B, Tang, A, Zeeshan, M, OKeeffe, T, Abbas, D, Latifi, R & Rhee, P 2016, 'Identifying the broken heart: Predictors of mortality and morbidity in suspected blunt cardiac injury', American Journal of Surgery, vol. 211, no. 6, pp. 982-988. https://doi.org/10.1016/j.amjsurg.2015.10.027
Joseph, Bellal ; Jokar, Tahereh O. ; Khalil, Mazhar ; Haider, Ansab A. ; Kulvatunyou, Narong ; Zangbar, Bardiya ; Tang, Andrew ; Zeeshan, Muhammad ; OKeeffe, Terence ; Abbas, Daniyal ; Latifi, Rifat ; Rhee, Peter. / Identifying the broken heart : Predictors of mortality and morbidity in suspected blunt cardiac injury. In: American Journal of Surgery. 2016 ; Vol. 211, No. 6. pp. 982-988.
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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.",
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AU - Kulvatunyou, Narong

AU - Zangbar, Bardiya

AU - Tang, Andrew

AU - Zeeshan, Muhammad

AU - OKeeffe, Terence

AU - Abbas, Daniyal

AU - Latifi, Rifat

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N2 - 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.

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