Troponin T in patients with traumatic chest injuries with and without cardiac involvement: Insights from an observational study

Abstract

Background:Serum troponin T (TnT) is a common marker of myocardial injury. However, its implication in the absence of clinical evidence of cardiac reason is not well established.Aims:The aim of this study was to identify the implications of positive TnT in traumatic chest injury (TCI) patients regardless of the cardiac involvement.Materials and Methods:We conducted a retrospective analysis of all TCI patients admitted to level 1 trauma center between 2008 and 2011. Patients who underwent TnT testing were divided into two groups: Group 1 (positive TnT) and Group 2 (negative TnT). The two groups were analyzed and compared, and multivariate regression analyses were performed to identify predictors of TnT positivity and mortality.Results:Out of 993 blunt TCI patients, 19.3% had positive TnT (Group 1). On comparison to Group 2, patients in Group 1 were 5 years younger and more likely to have head, cardiac, hepatic, splenic, and pelvic injuries, in addition to lung contusion. Positive TnT was associated with higher Injury Severity Score (ISS) (P = 0.001), higher chest Abbreviated Injury Score (AIS) (P = 0.001), and longer hospital stay (P = 0.03). In addition, Group 1 patients were more likely to undergo chest tube insertion, exploratory laparotomy, mechanical ventilation, and tracheostomy. Twenty patients had cardiac involvement, and of them 14 had positive TnT. Among 973 patients who showed no evidence of cardiac involvement, 178 had positive TnT (18.3%). There were 104 deaths (60% in Group 1). On multivariate regression analysis, the predictors of hospital mortality were positive TnT, head injury, and high ISS, whereas, the predictors of TnT positivity were cardiac, hepatic, and pelvic injuries; higher ISS; and age.Conclusions:Positive TnT in blunt TCI patients is a common challenge, particularly in polytrauma cases. Patients with positive TnT tend to have the worst outcome even in the absence of clinical evidence of acute cardiac involvement. Positive TnT is also a reflection of the severity of chest or extrathoracic injuries; however, further prospective studies are warranted.

Isolated right atrial rupture from blunt trauma: a case report with systematic review of a lethal injury

“…Other tests, such as cardiac biomarkers (CBMs), have been proposed for the diagnosis of BCRs. However, CBMs also have been shown to lack specificity, as Mahmood et al observed elevated CBMs in 20% of blunt chest trauma, even in the absence of cardiac involvement [60]. Recently, several studies, including a meta-analysis [54], have suggested the combined use of ECG and CBMs to rule out BCIs and/or monitor its progression [15].…”

In-Hospital Diagnosis of Tricuspid Papillary Muscle Rupture in an Asymptomatic Patient after Blunt Chest Trauma

“…Some authors proposed cardiac troponin level measurements as a screening test prior to echocardiographic workup and data suggests that severity of cardiac arrhythmias correlates with cardiac troponin levels [17, 23]. Moreover, even in the absence of clinical evidence of cardiac involvement, troponin leaks may be associated with worse outcomes in patients with blunt chest trauma [13]. Despite these insights, it is believed that cardiac contusions and associated structural cardiac injuries remain underdiagnosed [24].…”

Utilidad de las pruebas diagnósticas en el trauma cardiaco cerrado

“…Además, en los pacientes que presentaban trauma cardiaco cerrado, la troponina a las 6 horas del trauma aumentó (mediana de 1,78 µg/L), en comparación con una de 0,1 µg/L en quienes no lo sufrieron; no obstante, dado el escaso número de pacientes (n=6), no se pudo establecer una significación estadística. En el presente estudio, no se evaluó la troponina T, con gran especificidad y valor pronóstico en la morbimortalidad en casos de trauma cardiaco 24 .…”