Blunt Cardiac Injury, Screening for

Published 2012

Level 1

An admission electrocardiogram (ECG) should be performed on all patients in whom BCI is suspected (no change).

Level 2

  1. If the admission ECG reveals a new abnormality (arrhythmia, ST changes, ischemia, heart block, and unexplained ST changes), the patient should be admitted for continuous ECG monitoring. For patients with preexisting abnormalities, comparison should be made to a previous ECG to determine need for monitoring (updated).
  2. In patients with a normal ECG result and normal troponin I level, BCI is ruled out. The optimal timing of these measurements, however, has yet to be determined. Conversely, patients with normal ECG results but elevated troponin I level should be admitted to a monitored setting (new).
  3. For patients with hemodynamic instability or persistent new arrhythmia, an echocardiogram should be obtained. If an optimal transthoracic echocardiogram cannot be performed, the patient should have a transesophageal echocardiogram (updated).
  4. The presence of a sternal fracture alone does not predict the presence of BCI and thus should not prompt monitoring in the setting of normal ECG result and troponin I level (moved from Level 3).
  5. Creatinine phosphokinase with isoenzyme analysis should not be performed because it is not useful in predicting which patients have or will have complications related to BCI (modified and moved from Level 3).
  6. Nuclear medicine studies add little when compared with echocardiography and should not be routinely performed (no change).

Level 3

  1. Elderly patients with known cardiac disease, unstable patients, and those with an abnormal admission ECG result can safely undergo surgery provided that they are appropriately monitored. Consideration should be given to placement of a pulmonary artery catheter in such cases (no change).
  2. Troponin I should be measured routinely for patients with suspected BCI; if elevated, patients should be admitted to a monitored setting and troponin I should be followed up serially, although the optimal timing is unknown (new).
  3. Cardiac computed tomography (CT) or magnetic resonance imaging (MRI) can be used to help differentiate acute myocardial infarction (AMI) from BCI in trauma patients with abnormal ECG result, cardiac enzymes, and/or abnormal echo to determine need for cardiac catheterization and/or anticoagulation (new).