Key result
Blunt cardiac injury is linked to ~70% higher mortality in trauma patients.
Why the study?
Risk factors used for early assessment and improving the positive predictive value of blunt cardiac injury remain inconclusive.
What are the risk factors and outcomes associated with blunt cardiac injury in trauma patients?
Meta-Analysis (n=68,039)
What are the risk factors and outcomes associated with blunt cardiac injury in trauma patients?
Effect estimate: RR 1.70 (95% CI 1.53-1.90)
Blunt cardiac injury in trauma patients is associated with increased mortality and longer hospital stays, and screening is recommended for patients with sternal fracture, shock, or a history of cardiac disease.
Background and purpose: Risk factors that could be used to assess early and further improve the positive predictive value of blunt cardiac injury (BCI) are still inconclusive. We conducted a meta-analysis to quantitatively analyze the injury mechanism, risk factors, and outcomes associated with BCI in trauma patients. Methods: This systematic review and meta-analysis were performed to gather data on trauma patients with blunt cardiac injury. PubMed, Web of Science, and EMBASE databases were searched for studies until 20th November 2021. A pooled meta-analysis of injury mechanisms, risk factors, and outcomes concerning BCI was conducted. Results: We screened 256 records from which 11 studies published from 2000 to 2019 reporting 68,039 patients with trauma were included. Motor vehicle crash was the main injury mechanism, accounting for 65.2% of the attributed mechanisms for BCI [pool proportion = 0.652 (0.595–0.709)]. The pooled relative risks (RRs) revealed that patients with sternal fracture, shock on arrival, and history of cardiac disease were associated with increased risk of BCI (for sternal fracture: RR = 7.21 [95% confidence interval (CI) = 3.99–13.05]; for the shock on arrival: RR = 2.45, 95% CI = 2.12–2.84; for the history of cardiac disease: RR = 1.87, 95% CI = 1.11–3.16). A significant difference was observed in the length of stay between the BCI group compared to the no BCI group, 11.68 (95% CI = 8.79–14.58 days) vs. 20.46 (95% CI = 16.78–24.14 days). The risk of mortality was significantly higher in trauma patients with BCI as compared to those without BCI (RR = 1.70, 95% CI = 1.53–1.90). Conclusions: BCI was associated with increased mortality in our study. Patients also tended towards a longer length of stay. In addition to electrocardiogram and TnI, we recommend screening for BCI when trauma patients are in the presence of sternal fracture, shock, and a history of cardiac disease.
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Jiang et al. (2023) conducted a meta-analysis in Blunt cardiac injury in trauma patients (n=68,039). Blunt cardiac injury (BCI) vs. No blunt cardiac injury was evaluated on Mortality (RR 1.70, 95% CI 1.53-1.90). Blunt cardiac injury in trauma patients was associated with a significantly higher risk of mortality compared to patients without blunt cardiac injury (RR 1.70; 95% CI 1.53-1.90).
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