Table 1
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Adams JE, 1997, USAPatients with suspected cardiac traumaReview article including 3 relevant papersSerial TnT and total CKSensitivity 0.63 and specificity 0.71 for TnTExcluded those with pre-existing cardiac disease
CK and TnI over first 72 hours and ECHOSensitivity 1 and specificity 0.68 for TnIVery small numbers involved
TnI, CK and CK-MB at 12 and 24 hours and ECHOSpecificity 0.72 for TnI TnI specificity better than TnT specificity
TnT v TnI
Ferjani M et al, 1997, France128 consecutive patients who had suffered blunt chest trauma. All patients had TnT measured at admission, 4 and 24 hours after admission. Cardiac contusion defined as abnormal echocardiography compatible with contusion, severe cardiac rhythm abnormality, severe cardiac conduction abnormality or haemopericardiumecutive patients who had suffered blunt chest traumaProspective observational studySensitivity and specificity of troponin T >0.5 ug over 1st 24 hoursROC curve analysis performed AROC = 0.69 with 95% C.I. of 0.56 to 0.80Excludes patients with pre-existing coronary artery disease.
Troponin versus CKMBTnT of >0.5 ug has specificity of 0.91 but sensitivity of 0.31, indicating that it is unreliableOnly measured TnT at admission, 4 and 24 hours. Used TnT not TnI trop of >0.5 ug is a high level.
Trop T had greater AROC than CKMB or CKMB/CK ration
Mori F et al, 2001, Italy32 patients with clinical or radiological signs of acute blunt chest trauma. All patients had cTnI measured at 6, 12, 24, 48 and 96 hours post injury. Cardiac contusion defined as abnormal trans-oesophageal echocardiographyProspective observational studySensitivity of raised troponinAll with normal or minimally raised TnI (<0.4 ng/ml) had a normal echo (mean 0.6 +/−1.4)Excluded patients with pre-existing cardiac disease
Specificity of raised troponinMean TnI was higher in those with abnormal echo (mean 2.6 +/−1.6) p<0.0001Small numbers included in the study.
Kaye P et al, 2002, UKPatients with suspected myocardial contusion. ECG and ECHO used to define significant blunt cardiac injury.Review article including 3 relevant papersUtility of troponin to diagnose myocardial contusionAnimal studies suggest troponin may be useful. 2 Human studies show high sensitivity, 1 shows low spensitivity (but had questionable gold standard).Papers used variable gold standards, abnormal ECG, clinically significant finding and/or ECHO.
Authors concluded cardiac troponins seem to be highly specific and sensitive for myocardial injury. They may offer the possibility of stratification of severity and risk of adverse outcome.1 paper looked at ventilated trauma patients and none had an abnormal echo
Small numbers involved in the trials
Velmahos G et al, 2003, USA333 consecutive patients with significant blunt thoracic trauma. TnI was performed on all patients at admission, 4 and 8 hours post admission. Significant blunt cardiac injury was determined by any of the following: hypotension in the absence of bleeding or a neurogenic cause, cardiac arrhythmia, echocardiagraphic abnormality, severe arrhythmi,a or shock of unexplained originProspective observational studyClinical diagnosis of significant blunt cardiac injury. Serial ECG and TnI analysisNone with normal ECG and TnI at 8 hours were felt to have significant blunt cardiac injury. TnI was considered abnormal if values were greater than 1.5 ng/mLThe diagnosis of significant blunt cardiac injury was made clinically.
High cut off for raised TnI (1.5 ng/ml)
Sybrandy KC et al, 2003, NetherlandsPatients with suspected cardiac contusionReview article including 2 further relevant papersUtility of troponins to detect myocardial contusionSensitivity 100%, all with normal TnI had no problems. Specificity 83–87.5%One paper excluded intubated and haemodynamically unstable patients.
Small numbers involved in the trials