Cardiac injury and mortality after blunt chest trauma: a prospective observational cohort study

Mohamed T. Noweir; Amr A. Abdelwahab; Mohamed A. Elgariah; Amro R. Serag

doi:10.18203/2349-2902.isj20260840

Authors

Mohamed T. Noweir Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt https://orcid.org/0009-0009-1950-2784
Amr A. Abdelwahab Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt https://orcid.org/0000-0002-5625-8866
Mohamed A. Elgariah Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt https://orcid.org/0000-0003-4539-6750
Amro R. Serag Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt https://orcid.org/0000-0002-3466-1902

DOI:

https://doi.org/10.18203/2349-2902.isj20260840

Keywords:

Cardiac, Injury, Blunt, Chest, Trauma

Abstract

Background: Cardiac trauma is a serious injury that can occur after blunt chest trauma, posing a high risk of rapid deterioration and mortality. This study aims to evaluate cardiac injuries and mortality after blunt chest trauma.

Methods: This observational cohort study included 303 patients with blunt chest trauma, comprising 248 males (81.85%) and 55 females (18.15%), resulting in a male-to-female ratio of 4:1. The mean age was 39.26±19.89 years, with a range of 2 to 81 years. All patients underwent a clinical assessment, an injury severity evaluation using the injury severity score (ISS) and received various diagnostic tests.

Results: The overall mortality rate was 14.2% (43 out of 303 patients). Logistic regression analysis identified independent mortality predictors, including the mode of trauma, need for mechanical ventilation, ISS, and blunt cardiac injury (BCI). Our patients were divided into two groups; group I had 91 patients (30.03%) with BCI, showing a mortality rate of 27.5% (25 patients), significantly higher than the 8.5% (18 patients) in group II, without BCI.

Conclusions: BCI is an important independent predictor of mortality in cases of blunt chest trauma. Therefore, physicians need to prioritize early diagnosis and management of this condition.

Metrics

Metrics Loading ...

References

Eghbalzadeh K, Sabashnikov A, Zeriouh M, Choi Y-H, Bunck AC, Mader N, et al. Blunt chest trauma: A clinical chameleon. Heart. 2018;104(9):719-24. DOI: https://doi.org/10.1136/heartjnl-2017-312111

Lee C, Jebbia M, Morchi R, Grigorian A and Nahmias J. Cardiac trauma: A review of penetrating and blunt cardiac injuries. Am Surg. 2025;91(33):423-33. DOI: https://doi.org/10.1177/00031348241307400

Joseph B, Jokar TO, Khalil M, Haider AA, Kulvatunyou N, Zangbar B, et al. Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury. Am J Surg. 2016;211(6):982-8. DOI: https://doi.org/10.1016/j.amjsurg.2015.10.027

Gao JM, Li H, Wei GB, Liu CP, Du DY, Kong LW, et al. Blunt Cardiac Injury: A Single-Center 15-Year Experience. Am Surg. 2020;86(4):354-61. DOI: https://doi.org/10.1177/000313482008600432

Liu Y-c, Liu J-h, Fang ZA, Shan G-l, Xu J, Qi Z-w, et al. Modified shock index and mortality rate of emergency patients. World J Emerg Med Surg. 2012;3(2):114-9. DOI: https://doi.org/10.5847/wjem.j.issn.1920-8642.2012.02.006

Baker SP, O’Neill B, Haddon Jr W and Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma Acute Care Surg. 1974;14(3):187-96. DOI: https://doi.org/10.1097/00005373-197403000-00001

Van Ditshuizen JC, Sewalt CA, Palmer CS, Van Lieshout EMM, Verhofstad MHJ, Den Hartog D. The definition of major trauma using different revisions of the abbreviated injury scale. Scand J Trauma Resusc Emerg Med. 2021;29(1):71-90. DOI: https://doi.org/10.1186/s13049-021-00873-7

Nanjundeswaraswamy TS, Divakar S. Derermination of sample size and sampling methods in applied research. Proc Eng Sci. 2021;3(1):25-32. DOI: https://doi.org/10.24874/PES03.01.003

Ajee K, Valsan A, Sankaran R. Choosing the right statistical test: A guide for data analysis. Amrita J Med. 2024;20(2):86-8. DOI: https://doi.org/10.4103/AMJM.AMJM_27_24

Baratloo A, Hosseini M, Negida A, El Ashal G. Part 1: simple definition and calculation of accuracy, sensitivity and specificity. Emergency. 2015;3(2):48-55.

El-Menyar A, Latifi R, AbdulRahman H, Zarour A, Tuma M, Parchani A, et al. Age and traumatic chest injury: a 3-year observational study. Eur J Trauma Emerg Surg. 2013;39(4):397-403. DOI: https://doi.org/10.1007/s00068-013-0281-7

Serag A. Predictors of mortality in thoracic trauma. J Egypt Soc Cardio-Thorac Surg. 2007;15:107-11.

Gaillard M, Hervé C, Mandin L, Raynaud P. Mortality prognostic factors in chest injury. J Trauma. 1990;30(1):93-6. DOI: https://doi.org/10.1097/00005373-199001000-00015

Sikander N, Ahmad T, Shaikh KA, Abid A, Mazcuri M, Nasreen S. Analysis of Injury Patterns and Outcomes of Blunt Thoracic Trauma in Elderly Patients. Cureus. 2020;12(8):99-109. DOI: https://doi.org/10.7759/cureus.9974

Lien YC, Chen CH, Lin HC. Risk factors for 24-hour mortality after traumatic rib fractures owing to motor vehicle accidents: a nationwide population-based study. Ann Thorac Surg. 2009;88(4):1124-30. DOI: https://doi.org/10.1016/j.athoracsur.2009.06.002

Croce MA, Tolley EA, Fabian TC. A formula for prediction of posttraumatic pneumonia based on early anatomic and physiologic parameters. J Trauma Acute Care Surg. 2003;54(4):724-30. DOI: https://doi.org/10.1097/01.TA.0000054643.54218.C5

Magnotti LJ, Croce MA, Fabian TC. Is ventilator-associated pneumonia in trauma patients an epiphenomenon or a cause of death? Surg Infect. 2004;5(3):237-42. DOI: https://doi.org/10.1089/sur.2004.5.237

Champion HR. Trauma scoring. Scand J Surg. 2002;91(1):12-22. DOI: https://doi.org/10.1177/145749690209100104

Wang S-H, Wei T-S, Chen C-P. Prognostic analysis of patients with blunt chest trauma admitted to an intensive care unit. J Formos Med Assoc. 2007;106(6):444-51. DOI: https://doi.org/10.1016/S0929-6646(09)60293-X

Battle CE, Hutchings H, Evans PA. Expert opinion of the risk factors for morbidity and mortality in blunt chest wall trauma: results of a national postal questionnaire survey of Emergency Departments in the United Kingdom. Injury. 2013;44(1):56-9. DOI: https://doi.org/10.1016/j.injury.2011.12.012

Skinner DL, Laing GL, Rodseth RN, Ryan L, Hardcastle TC, Muckart DJ. Blunt cardiac injury in critically ill trauma patients: a single centre experience. Injury. 2015;46(1):66-70. DOI: https://doi.org/10.1016/j.injury.2014.08.051

Schultz JM, Trunkey DD. Blunt cardiac injury. Crit Care Clin. 2004;20(1):57-70. DOI: https://doi.org/10.1016/S0749-0704(03)00092-7

Grigorian A, Milliken J, Livingston JK, Spencer D, Gabriel V, Schubl SD, et al. National risk factors for blunt cardiac injury: Hemopneumothorax is the strongest predictor. Am J Surg. 2019;217(4):639-42. DOI: https://doi.org/10.1016/j.amjsurg.2018.07.043

Rosemurgy AS, Norris PA, Olson SM, Hurst JM, Albrink MH. Prehospital traumatic cardiac arrest: the cost of futility. J Trauma. 1993;35(3):468-73. DOI: https://doi.org/10.1097/00005373-199309000-00022

Howlett LA, Lancaster MK. Reduced cardiac response to the adrenergic system is a key limiting factor for physical capacity in old age. Exp Gerontol. 2021;150:11-39. DOI: https://doi.org/10.1016/j.exger.2021.111339

Mohammadzadeh S, Ahmadinejad I, Soltanian A, Ahmadinejad Y, Shirzadi A, Azizmanesh M, et al. Investigation of Cardiac Injuries, Including Contusions, in Patients with Blunt Chest Trauma. Open Cardiovasc Med J. 2025;19(1):33-45. DOI: https://doi.org/10.2174/0118741924381702250707184600

Anand R, Brooks Md Facs SE, Puckett Y, Richmond RE, Ronaghan CA. Pneumopericardium resulting from blunt thoracic trauma. Cureus. 2020;12(11):25-30. DOI: https://doi.org/10.7759/cureus.11625

Muckart DJJ, Hardcastle TC, Skinner DL. Pneumomediastinum and pneumopericardium following blunt thoracic trauma: much ado about nothing? Eur J Trauma Emerg Surg. 2019;45(5):927-31. DOI: https://doi.org/10.1007/s00068-018-0960-5

Agarwal D, Chandra S. Challenges in the diagnosis of blunt cardiac injuries. Indian J Surg. 2009;71(5):245-53. DOI: https://doi.org/10.1007/s12262-009-0078-4

Velmahos GC, Karaiskakis M, Salim A, Toutouzas KG, Murray J, Asensio J, et al. Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. J Trauma. 2003;54(1):45-50. DOI: https://doi.org/10.1097/00005373-200301000-00006

Salim A, Velmahos GC, Jindal A, Chan L, Vassiliu P, Belzberg H, et al. Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings. J Trauma. 2001;50(2):237-43. DOI: https://doi.org/10.1097/00005373-200102000-00008

Yousef R, Carr JA. Blunt cardiac trauma: A review of the current knowledge and management. Ann Thorac Surg. 2014;98(3):1-13. DOI: https://doi.org/10.1016/j.athoracsur.2014.04.043

Clancy K, Velopulos C, Bilaniuk JW, Collier B, Crowley W, Kurek S, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):301-6. DOI: https://doi.org/10.1097/TA.0b013e318270193a

Kyriazidis IP, Jakob DA, Vargas JAH, Franco OH, Degiannis E, Dorn P, et al. Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis. World J Emerg Surg. 2023;18(1):36-50. DOI: https://doi.org/10.1186/s13017-023-00504-9

Weber B, Lackner I, Gebhard F, Miclau T, Kalbitz M. Trauma, a matter of the heart—molecular mechanism of post-traumatic cardiac dysfunction. J Mol Sci. 2021;22(2):737-45. DOI: https://doi.org/10.3390/ijms22020737