Table 1 Review of Myocardial Contusion Evaluation in Blunt Thoracic Trauma

Baxter, et al. [19]

Retrospective 6 year review of all patients with blunt chest trauma

280

35 patients with myocardial contusion (MCC)

7 complications

2 deaths

* Complications of MCC manifest within 12 hours.

* Patients with suspected MCC should have cardiac monitor and enzyme monitoring for 24 hours or until hemodynamically and electrically stable.

* Patients with known coronary artery disease should have monitoring until hemodynamically stable and a myocardial infarction is ruled out.

* Echocardiogram is helpful to further evaluate MCC.

Biffl, et al. [3]

Retrospective 4-year review of all patients with high-risk blunt chest trauma

359

107 MCC

14 dysrhythmias

3 cardiogenic shock

with 2 deaths

* Cardiac enzymes (CPK, CKMB) have no useful role in the evaluation of patients with myocardial contusion.

* Risk factors associated with complications from MCC include age > 55, abnormal admission EKG (except sinus tachycardia), absence of chest pain, head injury with GCS < 8, and pelvic fracture.

Cachecho, et al [20]

Retrospective 6-year review of patients with blunt thoracic trauma

336

19

*Young patients with minor blunt thoracic trauma and minimally abnormal EKG do not benefit from cardiac monitoring.

* Evaluation of MCC should not be pursued in hemodynamically stable patients.

Karalis, et al [21]

12-month prospective evaluation of patients admitted with blunt thoracic trauma

105

8

* Only patients who have complications from MCC benefit from echocardiogram. Transesophageal echo may be beneficial if thoracic trauma limits the quality of a trans-thoracic study.

Adams, et al. [22]

12-month prospective evaluation of patients with blunt thoracic trauma

44

2 acute myocardial infarctions

Cardiac troponin I accurately detects cardiac injury after blunt chest trauma.