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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 4/2021

Open Access 01-08-2021 | Blunt Thoracic Trauma | Original Article

Diagnostic approach for myocardial contusion: a retrospective evaluation of patient data and review of the literature

Authors: Esther M. M. Van Lieshout, Michael H. J. Verhofstad, Dirk Jan T. Van Silfhout, Eric A. Dubois

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2021

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Abstract

Purpose

Myocardial 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.

Methods

Sensitivity and specificity were first determined in a 10-year retrospective cohort study and second by a systematic literature review with meta-analysis.

Results

Of 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.

Conclusion

The 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.
Appendix
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Metadata
Title
Diagnostic approach for myocardial contusion: a retrospective evaluation of patient data and review of the literature
Authors
Esther M. M. Van Lieshout
Michael H. J. Verhofstad
Dirk Jan T. Van Silfhout
Eric A. Dubois
Publication date
01-08-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-020-01305-4

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