Cardiac Troponin I Is Increased in Patients with Polytrauma and Chest or Head Trauma. Results of A Retrospective Case-Control Study

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Summary

Background: We performed a retrospective case-control study to assess the values of cardiac troponin I (cTnI) in a large number of patients admitted to the emergency department (ED) with different types of trauma.

Methods: The study population consisted of all patients aged 18 years or older admitted to the local ED with all types of traumas over a 1-year period. Results of cTnI were compared with those of 125 consecutive blood donors and 25 non-cardiac chest pain ED patients.

Results: The final study population consisted of 380 trauma patients, 10 with isolated abdominal trauma, 99 with isolated trauma of the limbs, 49 with isolated chest trauma, 145 with isolated head trauma and 77 with polytrauma. The concentration of cTnI did not differ among the three study populations, but the frequency of measurable values was substantially higher in patients with trauma (63%) than in blood donors and non-cardiac chest pain ED patients (both 20%). The frequency of cTnI values above the 99th percentile of the reference range was significantly higher in trauma patients (20%) than in blood donors (0%) and noncardiac chest pain ED patients (8%). Increased cTnI values were more frequent after head trauma (21%), chest trauma (27%) and polytrauma (29%) compared to patients with abdominal (0%) or limbs trauma (8%).

Conclusions: These results suggest that the measurement of cardiac troponin may be advisable to identify potential cardiac involvement in trauma patients, especially in those with polytrauma and head or chest trauma.

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  • 1. Murray CJ Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997; 349: 1498-504.

  • 2. US National Trauma Institute. Trauma Statistics. Available at: http://www.nationaltraumainstitute.org/home/trauma_statistics.html. Last access: January 5 2015.

  • 3. Søreide K Krüger AJ Vårdal AL Ellingsen CL Søreide E Lossius HM. Epidemiology and contemporary patterns of trauma deaths: changing place similar pace older face. World J Surg 2007; 31: 2092-103.

  • 4. Evans JA van Wessem KJ McDougall D Lee KA Lyons T Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 2010; 34: 158-63.

  • 5. US Centers for Disease Control and Prevention. Emergency Department Visits. Available at: http://www.cdc.gov/nchs/fastats/emergency-department.htm. Last access: January 5 2015.

  • 6. Prekker ME Miner JR Rockswold EG Biros MH. The prevalence of injury of any type in an urban emergency department population. J Trauma 2009; 66: 1688-95.

  • 7. Mahajan VS Jarolim P. How to interpret elevated cardiac troponin levels. Circulation 2011; 124: 2350-4.

  • 8. Cervellin G Lippi G. Of MIs and men - a historical perspective on the diagnostics of acute myocardial infarction. Semin Thromb Hemost 2014; 40: 535-43.

  • 9. Hamm CW Giannitsis E Katus HA. Cardiac troponin elevations in patients without acute coronary syndrome. Circulation 2002; 106: 2871-2.

  • 10. Lippi G Cervellin G. The latest generation of troponin immunoassays: the »cholesterol« of the third millennium? J Am Coll Cardiol 2014; 63: 2883-4.

  • 11. Wilcox G Archer PD Bailey M Dziukas L Lim CF Schneider HG. Measurement of cardiac troponin I levels in the emergency department: predictive value for cardiac and all-cause mortality. Med J Aust 2001; 174: 170-3.

  • 12. Reynolds T Cecconi M Collinson P Rhodes A Grounds RM Hamilton MA. Raised serum cardiac troponin I concentrations predict hospital mortality in intensive care unit patients. Br J Anaesth 2012; 109: 219-24.

  • 13. Lippi G Dipalo M Avanzini P Formentini A Aloe R. Analytical assessment of the Beckman Coulter Unicel DxI AccuTnI+3 immunoassay. Diagnosis 2014; 1: 195-7.

  • 14. Cervellin G Robuschi F Scioscioli F Ruffini L Dipalo M Salvagno GL et al. Dipyridamole Stress Echocardio - graphy Does Not Trigger Release of Highly-Sensitive Troponin I and T. J Med Biochem 2014; 33: 376-83.

  • 15. Uettwiller-Geiger D Wu AH Apple FS Jevans AW Venge P Olson MD et al. Multicenter evaluation of an automated assay for troponin I. Clin Chem 2002; 48: 869-76.

  • 16. Gunst M Ghaemmaghami V Gruszecki A Urban J Frankel H Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc (Bayl Univ Med Cent) 2010; 23: 349-54.

  • 17. Kam C Lai CH Lam S So F Lau C Cheung KH. What are the ten new commandments in severe polytrauma management? World J Emerg Med 2010; 1: 85-92.

  • 18. De Palma R Meier P. Troponin: a risk marker beyond heart disease. Open Heart 2014; 1: e000009.

  • 19. Martin M Mullenix P Rhee P Belzberg H Demetriades D Salim A. Troponin increases in the critically injured patient: mechanical trauma or physiologic stress? J Trauma 2005; 59: 1086-91.

  • 20. Edouard AR Felten ML Hebert JL Cosson C Martin L Benhamou D. Incidence and significance of cardiac troponin I release in severe trauma patients. Anesthesiology 2004; 101: 1262-8.

  • 21. Bennett BL Steele P Dixon CA Mahabee-Gittens EM Peebles J Hart KW et al. Serum Cardiac Troponin I in the Evaluation of Nonaccidental Trauma. J Pediatr 2015; 167: 669-73.e1.

  • 22. Lindner G Pfortmueller CA Braun CT Exadaktylos AK. Non-acute myocardial infarction-related causes of elevated high-sensitive troponin T in the emergency room: a cross-sectional analysis. Intern Emerg Med 2014; 9: 335-9.

  • 23. Salim A Hadjizacharia P Brown C Inaba K Teixeira PG Chan L et al. Significance of troponin elevation after severe traumatic brain injury. J Trauma 2008; 64: 46-52.

  • 24. Prathep S Sharma D Hallman M Joffe A Krishna - moorthy V Mackensen GB et al. Preliminary report on cardiac dysfunction after isolated traumatic brain injury. Crit Care Med 2014; 42: 142-7.

  • 25. Ferjani M Droc G Dreux S Arthaud M Goarin JP Riou B et al. Circulating cardiac troponin T in myocardial contusion. Chest 1997; 111: 427-33.

  • 26. Bertinchant JP Polge A Mohty D Nguyen-Ngoc-Lam R Estorc J Cohendy R et al. Evaluation of incidence clinical significance and prognostic value of circulating cardiac troponin I and T elevation in hemodynamically stable patients with suspected myocardial contusion after blunt chest trauma. J Trauma 2000; 48: 924-31.

  • 27. Courtney D Conway R Kavanagh J O’Riordan D Silke B. High-sensitivity troponin as an outcome predictor in acute medical admissions. Postgrad Med J 2014; 90: 311-6.

  • 28. Lippi G. Biomarkers: Novel troponin immunoassay for early ACS rule-out. Nat Rev Cardiol 2016; 13: 9-10.

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