Epidemiology of myocardial injury in trauma patients: proposed phenotypes for future research.

Abstract

Purpose: To describe the epidemiology of myocardial injury in trauma patients, in doing so informing design for future multicentre prospective studies.

Method: A one-year retrospective study ending on 31/08/2023 was conducted at a Level-1 Trauma Centre. All adult trauma resuscitation patients with elevated Troponin serum concentration were included. Patient demographics, medical history, mechanism, injury severity, laboratory data, cardiac investigations, LOS, ICU admission and mortality were collected. Patients were categorised into three pragmatic groups based on the timing of their Troponin peak (Group1:<12 h; Group2:12-24 h; Group3:>24 h).

Results: From 1408 admissions, 97(7%) patients [Age:57(35,80); Male:71%; ISS:18(9-33); LOS:9(4,16.5); ICU:66%; Mortality:16.5%] had elevated Troponin. Group 1 [n = 37; Age:47(24,70); Male:76%; ISS:9(4,22); LOS:7(3,14); ICU:51%; Mortaliy:5.4%]; Group 2 [n = 32; Age:53.5(26,74); Male:78%; ISS:27(12.5,53.5); LOS:10(5,17); ICU:84%; Mortaliy:25%] and Group 3 [n = 28; Age:78(62,84); Male:57%; ISS:19(9.5,47.5); LOS:12.5(6,19.5); ICU:64%; Mortaliy:21%]. 64% of patients had thoracic injuries, which was consistent among the three groups. Group 3 had most frequent ECG (61%) and echocardiography (25%) findings.

Conclusion: Troponin elevation occurs in 7% of all trauma admissions and it identifies the seriously injured high-risk cohort. The timing of the maximum Troponin concentration seems to describe three distinct phenotypes. "Hyperacute" with most favourable outcomes, "Subacute" with severe trauma and tissue injury requiring major resource utilisation and associated with the highest mortality rate, and "Late" characterised by ECG and ECHO changes suggesting primary ischaemic cardiac pathology.