INCIDENCE, PREDICTORS AND OUTCOMES OF BLUNT CARDIAC INJURY AMONG TRAUMA PATIENTS PRESENTING TO A TERTIARY HOSPITAL IN TANZANIA

Abstract

Background/objective: Blunt cardiac injury (BCI) incidence varies due to non-specific presentation and lack of diagnostic clinical gold standard. BCI screening is often not done in LMIC despite high trauma burden. We aimed to establish incidence, predictors and outcomes (48-hour and 7-day) of BCI among polytrauma or isolated blunt chest injury patients who attended the ED of Muhimbili National Hospital-Tanzania, with the goal of developing a standard algorithm to guide use of scarce resources in LMIC to target BCI screening

Methods: Prospective observational cohort study between September 2023-February 2024, with consecutive enrollment of polytrauma or isolated blunt chest trauma patients. BCI was defined as abnormal ECG and elevated troponin. All patients received ECG and if abnormal, troponin was done. Patients meeting BCI criteria were followed up at 48 hours and 7 days after disposition for death and composite adverse events (Mechanical ventilation, hypotension, cardiorespiratory arrest resuscitated). Logistic regression analysis was performed to identify independent predictors of BCI.

Results: 73 of 315 patients screened had BCI, an incidence of 23.2% [95% CI: 18.6 %- 28.2%]. BCI patients had median age 31years (IQR: 22.5 – 39.5), and predominantly male 65(89%). Most were polytrauma 68(93.2%) with 57 (78.1%) involved in motor traffic accidents. 24-hour cardiac monitoring was performed in 30 (41.1%) patients while ECHO was performed in one. Mortality at 48hours was 6.8%, 9.6% at 7 days. Composite adverse events at 48hours and 7 days was 39.7% and 42.5% respectively. Tachycardia on ED arrival, GCS £12 and lung contusion were independent predictors of BCI (p<0.05).

Conclusion: There is a significant incidence of BCI among polytrauma/isolated blunt chest trauma in our setting, suggesting the need to include BCI screening and cardiac monitoring guidelines in our trauma algorithms. Predictors of tachycardia, GCS£ 12 and lung contusion can be used to target screening to conserve resource use.