Table 1.
The utility of diagnostic modalities for blunt cardiac injury
| Diagnostic modality | Findings suggesting BCI | Sensitivity | Specificity | References | Pros | Cons | Level of Evidence |
|---|---|---|---|---|---|---|---|
| Chest X ray | Widen mediastinum, haemo/pneumomediastinum | 57%-100% | 33%-90.2% | [46,47] | Simple, fast, and low radiation | Non-specific and variable sensitivity | Level 4 (case series) |
| Electrocardiography | Unspecific ST-T changes; tachycardia; atrial fibrillation; bradycardia | 50%-89% | 23%-67% | [23,48,49] | Simple, available, and inexpensive | Insensitive and nonspecific | Level 4 (case series) |
| Highly sensitive troponin | An increase of 20% from baseline or > 14 ng/L | 23%-100% | 21%-97% | [5,27,48,50] | Sensitive | Not available in every setting; variable specificity | Level 4 (case series) |
| Focused assessment with sonography for trauma | Pericardial effusion; hemopericardium | 83.3%-100% | 99.7% | [51,52] | Feasibly done at the bedside, moderately specific, accuracy dependent on training | Operator dependent, variable sensitivity, requires training and practice | Level 2-4 (prospective cohort, case series) |
| Transthoracic echocardiography | Pericardial effusion; valvular regurgitation; abnormal regional wall motion | Up to 100% | N/A | [4,29,30,53] | Feasibly done at the bedside and specific | Operator dependent and variable sensitivity | Level 4 (case series) |
| Transesophageal echocardiography | Pericardial effusion; valvular regurgitation; abnormal regional wall motion | Up to 100% | N/A | [8,45,54] | Higher specificity than TTE | Challenging in cervical spine traumas and technically demanding | Level 4 (case series) |
| Computed tomography | Pericardial effusion, epicardial fat stranding, abnormal heart (defined by the radiologist) | 22%-78% | 55%-95% | [45,55,56] | Highly sensitive, fast and specific | High-dose radiation | Level 2-4 (prospective cohort, case series) |
| Magnetic resonance imaging | Myocardial edema, haemorrhage , or inflammation, and regional wall motion abnormalities | 60% | 81% | [8,35,50] | Moderate sensitivity but high accuracy and specificity | Time-consuming in trauma setting; the field is evolving. | Level 4 (case series) |