The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains. To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician. A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I2 and the QUADAS-2 tool was used to assess bias of the studies. This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4–36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8–98.2%) and sensitivity of 86.7% (range 40–99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832–7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries. Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases.

中文翻译：

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胸部钝性损伤后心脏损伤诊断测试的准确性：系统评价和荟萃分析

由于钝性胸部创伤引起的心脏挫伤引起的非特异性症状以及缺乏诊断心肌损伤的理想测试，诊断仍然是一个挑战。如果不及时诊断和治疗，心脏挫伤可能会危及生命。几种诊断测试已用于评估心脏并发症的风险，但识别挫伤患者的挑战仍然存在。旨在评估在急诊科或任何一线急诊医生进行评估的严重胸部损伤患者中检测钝性心脏损伤 (BCI) 及其并发症的诊断测试的准确性。从 1993 年到 2022 年 10 月，使用 Ovid MEDLINE 和 Embase 数据库执行了有针对性的搜索策略。至少有以下一项诊断测试的数据：心电图 (ECG)、血清肌酐磷酸激酶 MB 水平 (CPK-MB)、超声心动图 (Echo)、心肌肌钙蛋白 I (cTnI) 或心肌肌钙蛋白 T (cTnT)。在荟萃分析中评估了心脏挫伤诊断测试的准确性。使用 I2 评估异质性，并使用 QUADAS-2 工具评估研究的偏倚。这项系统评价产生了 51 项研究 (n = 5,359)。遭受钝力创伤后心肌损伤的加权平均发生率为 18.3%。钝性心脏损伤患者的总体加权平均死亡率为 7.6% (1.4–36.4%)。初始心电图、cTnI、cTnT 和经胸超声心动图 TTE 均表现出较高的特异性（> 80%），但敏感性较低（< 70%）。TEE 的特异性为 72.1%（范围 35.8-98.2%），敏感性为 86.7%（范围 40-99）。2%）用于诊断心脏挫伤。CK-MB 的诊断比值比最低，为 3.598（95% CI：1.832–7.068）。正常心电图伴随正常 cTnI 显示排除心脏损伤的灵敏度高达 85%。急诊医生在诊断钝性外伤患者的心脏损伤时面临着巨大的挑战。在大多数情况下，联合使用心电图和 cTnI 是排除心脏损伤的实用且经济有效的方法。此外，TEE 在识别疑似病例的心脏损伤方面可能非常准确。在大多数情况下，联合使用心电图和 cTnI 是排除心脏损伤的实用且经济有效的方法。此外，TEE 在识别疑似病例的心脏损伤方面可能非常准确。在大多数情况下，联合使用心电图和 cTnI 是排除心脏损伤的实用且经济有效的方法。此外，TEE 在识别疑似病例的心脏损伤方面可能非常准确。