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Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis

INTRODUCTION: The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnos...

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Autores principales: Kyriazidis, Ioannis Panagiotis, Jakob, Dominik A., Vargas, Juliana Alexandra Hernández, Franco, Oscar H., Degiannis, Elias, Dorn, Patrick, Pouwels, Sjaak, Patel, Bijendra, Johnson, Ian, Houdlen, Christopher John, Whiteley, Graham S., Head, Marion, Lala, Anil, Mumtaz, Haroon, Soler, J. Agustin, Mellor, Katie, Rawaf, David, Ahmed, Ahmed R., Ahmad, Suhaib J. S., Exadaktylos, Aristomenis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225099/
https://www.ncbi.nlm.nih.gov/pubmed/37245048
http://dx.doi.org/10.1186/s13017-023-00504-9
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author Kyriazidis, Ioannis Panagiotis
Jakob, Dominik A.
Vargas, Juliana Alexandra Hernández
Franco, Oscar H.
Degiannis, Elias
Dorn, Patrick
Pouwels, Sjaak
Patel, Bijendra
Johnson, Ian
Houdlen, Christopher John
Whiteley, Graham S.
Head, Marion
Lala, Anil
Mumtaz, Haroon
Soler, J. Agustin
Mellor, Katie
Rawaf, David
Ahmed, Ahmed R.
Ahmad, Suhaib J. S.
Exadaktylos, Aristomenis
author_facet Kyriazidis, Ioannis Panagiotis
Jakob, Dominik A.
Vargas, Juliana Alexandra Hernández
Franco, Oscar H.
Degiannis, Elias
Dorn, Patrick
Pouwels, Sjaak
Patel, Bijendra
Johnson, Ian
Houdlen, Christopher John
Whiteley, Graham S.
Head, Marion
Lala, Anil
Mumtaz, Haroon
Soler, J. Agustin
Mellor, Katie
Rawaf, David
Ahmed, Ahmed R.
Ahmad, Suhaib J. S.
Exadaktylos, Aristomenis
author_sort Kyriazidis, Ioannis Panagiotis
collection PubMed
description INTRODUCTION: The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains. AIM OF THE STUDY: To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician. METHODS: A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I(2) and the QUADAS-2 tool was used to assess bias of the studies. RESULTS: This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4–36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8–98.2%) and sensitivity of 86.7% (range 40–99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832–7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries. CONCLUSION: Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13017-023-00504-9.
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spelling pubmed-102250992023-05-29 Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis Kyriazidis, Ioannis Panagiotis Jakob, Dominik A. Vargas, Juliana Alexandra Hernández Franco, Oscar H. Degiannis, Elias Dorn, Patrick Pouwels, Sjaak Patel, Bijendra Johnson, Ian Houdlen, Christopher John Whiteley, Graham S. Head, Marion Lala, Anil Mumtaz, Haroon Soler, J. Agustin Mellor, Katie Rawaf, David Ahmed, Ahmed R. Ahmad, Suhaib J. S. Exadaktylos, Aristomenis World J Emerg Surg Review INTRODUCTION: The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains. AIM OF THE STUDY: To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician. METHODS: A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I(2) and the QUADAS-2 tool was used to assess bias of the studies. RESULTS: This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4–36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8–98.2%) and sensitivity of 86.7% (range 40–99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832–7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries. CONCLUSION: Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13017-023-00504-9. BioMed Central 2023-05-27 /pmc/articles/PMC10225099/ /pubmed/37245048 http://dx.doi.org/10.1186/s13017-023-00504-9 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Review
Kyriazidis, Ioannis Panagiotis
Jakob, Dominik A.
Vargas, Juliana Alexandra Hernández
Franco, Oscar H.
Degiannis, Elias
Dorn, Patrick
Pouwels, Sjaak
Patel, Bijendra
Johnson, Ian
Houdlen, Christopher John
Whiteley, Graham S.
Head, Marion
Lala, Anil
Mumtaz, Haroon
Soler, J. Agustin
Mellor, Katie
Rawaf, David
Ahmed, Ahmed R.
Ahmad, Suhaib J. S.
Exadaktylos, Aristomenis
Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis
title Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis
title_full Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis
title_fullStr Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis
title_full_unstemmed Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis
title_short Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis
title_sort accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225099/
https://www.ncbi.nlm.nih.gov/pubmed/37245048
http://dx.doi.org/10.1186/s13017-023-00504-9
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