Risk factors and outcomes of blunt cardiac injury in adult motor vehicle collision patients

OBJECTIVES: Motor vehicle protective equipment, such as seatbelts and airbags, has improved occupant safety. However, while seatbelts reduce facial and abdominal injuries, they may not significantly prevent head, neck, or thoracic trauma. Limited data exist on blunt cardiac injury (BCI). This study evaluated patterns of BCI, associated thoracic injuries, and hospital outcomes in adult trauma patients following motor vehicle collisions (MVCs). METHODS: We analyzed the 2023 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database for adult MVC occupants. Abbreviated Injury Scale codes 4208xx.x, 4404xx.x, 4410xx.x, 4412xx.x, 4413xx.x, and 4416xx.x identified patients with BCI. Those without BCI formed the reference cohort. A 1:1 propensity score match (PSM) on Injury Severity Score (ISS) was performed using RStudio to balance collision severity. RESULTS: In the overall cohort, the incidence of BCI was 1.2% (1,914/161,446). After PSM, 1,914 patients remained in each cohort with a mean ISS of 22.7. Both seatbelt plus airbag use and airbag use alone were independently associated with increased odds of BCI. BCI was strongly associated with thoracic injuries, including sternum fracture (odds ratio [OR] 3.492; 95% CI 2.95-4.14), hemothorax (OR 2.928; 95% CI 2.29-3.75), thoracic aortic injury (OR 1.773; 95% CI 1.29-2.44), and pulmonary contusion (OR 1.382; 95% CI 1.18-1.62). In multivariable analysis with BCI as the outcome, mortality (OR 2.325; 95% CI 1.93-2.79) and cardiac arrest (OR 1.827; 95% CI 1.29-2.59) were independently associated with BCI. CONCLUSION: Protective equipment use correlates with BCI and thoracic trauma. In MVC patients using seatbelts and airbags, concomitant chest injuries should heighten suspicion for BCI and prompt further evaluation.