PDF(Pubmed)
Abstract：
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.
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.
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 I2 and the QUADAS-2 tool was used to assess bias of the studies.
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.
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.
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.
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 I2 and the QUADAS-2 tool was used to assess bias of the studies.
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.
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.
摘要：
背景：心脏挫伤的诊断，由钝性胸部创伤引起的，由于其引起的非特异性症状以及缺乏诊断心肌损伤的理想测试，仍然是一个挑战。如果不及时诊断和治疗，心脏挫伤可能危及生命。已经使用了几种诊断测试来评估心脏并发症的风险，但是识别挫伤患者的挑战仍然存在。
目的：为了评估诊断性试验检测钝性心脏损伤（BCI）及其并发症的准确性，严重胸部受伤的患者，在急诊科或任何一线急诊医生进行评估。
方法：从1993年到2022年10月，使用OvidMEDLINE和Embase数据库进行了有针对性的搜索策略。以下至少一项诊断测试的数据：心电图（ECG），血清肌酐磷酸激酶-MB水平（CPK-MB），超声心动图(Echo),心肌肌钙蛋白I(cTnI)或心肌肌钙蛋白T(cTnT)。在荟萃分析中评估了心脏挫伤的诊断测试的准确性。使用I2评估异质性，并使用QUADAS-2工具评估研究的偏倚。
结果：本系统综述产生了51项研究（n=5,359）。钝器创伤后心肌损伤的加权平均发生率为18.3％。钝性心脏损伤患者的总加权平均死亡率为7.6％（1.4-36.4％）。初始心电图,cTnI,cTnT和经胸超声心动图TTE均显示高特异性(>80%),但灵敏度较低(<70%)。TEE诊断心脏挫伤的特异性为72.1％（范围35.8-98.2％），敏感性为86.7％（范围40-99.2％）。CK-MB的诊断比值比最低，为3.598（95％CI：1.832-7.068）。伴有正常cTnI的正常ECG在排除心脏损伤方面显示出85％的高灵敏度。
结论：急诊医师在诊断钝性创伤后患者的心脏损伤方面面临巨大挑战。在大多数情况下,联合使用ECG和cTnI是排除心脏损伤的一种务实且经济有效的方法.此外,TEE在可疑病例中可以高度准确地识别心脏损伤。
目的：为了评估诊断性试验检测钝性心脏损伤（BCI）及其并发症的准确性，严重胸部受伤的患者，在急诊科或任何一线急诊医生进行评估。
方法：从1993年到2022年10月，使用OvidMEDLINE和Embase数据库进行了有针对性的搜索策略。以下至少一项诊断测试的数据：心电图（ECG），血清肌酐磷酸激酶-MB水平（CPK-MB），超声心动图(Echo),心肌肌钙蛋白I(cTnI)或心肌肌钙蛋白T(cTnT)。在荟萃分析中评估了心脏挫伤的诊断测试的准确性。使用I2评估异质性，并使用QUADAS-2工具评估研究的偏倚。
结果：本系统综述产生了51项研究（n=5,359）。钝器创伤后心肌损伤的加权平均发生率为18.3％。钝性心脏损伤患者的总加权平均死亡率为7.6％（1.4-36.4％）。初始心电图,cTnI,cTnT和经胸超声心动图TTE均显示高特异性(>80%),但灵敏度较低(<70%)。TEE诊断心脏挫伤的特异性为72.1％（范围35.8-98.2％），敏感性为86.7％（范围40-99.2％）。CK-MB的诊断比值比最低，为3.598（95％CI：1.832-7.068）。伴有正常cTnI的正常ECG在排除心脏损伤方面显示出85％的高灵敏度。
结论：急诊医师在诊断钝性创伤后患者的心脏损伤方面面临巨大挑战。在大多数情况下,联合使用ECG和cTnI是排除心脏损伤的一种务实且经济有效的方法.此外,TEE在可疑病例中可以高度准确地识别心脏损伤。
