Cardiac Evaluation of Children Presenting with Trauma

Cardiac Evaluation of Children Presenting with Trauma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cardiac Evaluation of Children Presenting with Trauma Mahmut Yaman, Mehmet TÜRE, Alper AKIN, Duygu UÇ, Mehmet Sürücü, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3866204/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Elevated plasma levels of cardiac troponin in polytrauma patients may be associated with the severity of injury and mortality. In this study, we aimed to determine the predictive value of troponin and the effect of cardiac evaluations on prognosis in pediatric patients admitted to the emergency department due to trauma. In the study, 97 patients aged 0-18 years who presented with trauma were included. The cause and severity of the trauma, electrocardiography and echocardiography results, and laboratory data (biochemical, hemogram, C-reactive protein, pro-BNP, CK-MB, troponin, etc.) of the patients were evaluated. Falling from height was the most common cause of injury (43%). In 55 (56%) patients, chest trauma was found. Troponin elevation was present in all patients with chest trauma. Troponin levels were found to be statistically significantly higher in patients with chest trauma compared to those who did not have chest trauma (p=0.011). While the mean Sequential Organ Failure Assessment Score (SOFA) of the patients who were discharged was 4.94±2.58, the mean SOFA score of the patients who died was found to be statistically higher with 10.78±1.39 (≤0.01). Our findings have revealed the prognostic value of cardiac troponins in terms of direct or indirect injury to the heart, especially in pediatric patients with chest trauma. Therefore, in children presenting with chest trauma, determining the cardiac injury by evaluating the electrocardiography results, which can be easily accessed in every health center, and cardiac troponins may be a guide in terms of patient prognosis. Trauma troponin children prognosis What Is Known In previous studies, cardiac involvement due to trauma was evaluated in adults. In our literature review, we found only one article on this subject in children. What is New: Our findings reveal the prognostic value of cardiac troponins in terms of direct or indirect impact on the heart, especially in pediatric patients with chest trauma. We think that our article will make a great contribution to the literature, since there is no other study reaching these results. Introduction Trauma is a major public health issue and one of the most important causes of death, especially because it affects the young age group and causes financial and moral loss ( 1 ). It is known that in 1/3 of trauma patients, severe chest trauma is the cause of hospitalization, and 20–25% of deaths occur due to chest trauma 1,2 . In children, the rib cage is more flexible than adults, making them more prone to thoracic injuries 3 . Lung contusion may lead to impaired gas exchange followed by hypoxemia, often without evident external signs of injury 4 . In addition, blunt cardiac injuries in children have been reported to cause significant arrhythmias 5 and even prolonged cardiac dysfunction 6 . Cardiomyocyte injury is determined by evaluating cardiac troponin levels and electrocardiography (ECG) and echocardiography (ECHO) results 7 . Cardiac troponins are considered to be the most sensitive and specific biomarkers for the diagnosis of cardiomyocyte injury. As in other mechanisms, these biomarkers are released into the circulation in the presence of myocardial or cardiomyocyte injury, providing meaningful results for acute cardiac ischemia 8,9 . Elevated plasma levels of cardiac troponin in polytrauma patients are associated with the severity of injury and mortality 7 ; however, their predictive value for cardiac injury is still being discussed 10 . In terms of pediatric PT, little is known about the importance of troponin assessment in the emergency department and its role in predicting outcome-related endpoints 11 . The aim of this study is to determine the predictive value of troponin, which is used as a biomarker of cardiac injury in practice in pediatric patients admitted to the emergency department due to trauma, and the effect of cardiac evaluation of patients on prognosis. Materials and Methods Study Population In this study, 97 patients aged 0–18 years, who were admitted to the emergency department of our hospital between January 2015 and January 2022 due to trauma, were included. Sociodemographic characteristics of the patients (age, gender), the cause and severity of the trauma, sequential organ failure assessment score (SOFA), patient progression, electrocardiography and echocardiography results, laboratory data (biochemical, hemogram, C-reactive protein, pro-BNP, CK-MB, troponin, etc.) were evaluated retrospectively. Patients with a medical history of cardiac disease were excluded from the study. Statistical Analysis Statistical analysis of the data was performed using SPSS 24 (SPSS Inc., Chicago, Illinois) software. The conformity of the variables to normal distribution was examined using visual (histogram and probability plots) and analytical methods (Kolmogorov-Smirnov/Shapiro-Wilk tests). Descriptive statistics were expressed as median for non-normally distributed variables and as mean for normally distributed variables. For the relationships between variables, at least one of which was non-normally distributed or ordinal, correlation coefficients and statistical significance were calculated using the Spearman’s Rank Correlation or Pearson's Correlation Coefficient. In the comparison of quantitative variables between the two groups, the Student’s T-test or Mann-Whitney U test was used. The Chi-square test was used to compare categorical variables. Statistical significance level (bidirectional) was chosen as α < 0.05. Results A total of 97 trauma patients, 32 (33%) female and 65 (67%) male, were included in the study. The mean age and standard deviation score of the female patients were found as 150 ± 55.1 months, and the mean age and standard deviation score of the male patients were found as 100.5 ± 63.1 (Table 1). When the patients were examined according to the trauma mechanisms, blunt injuries were found in 92% and penetrating injuries were found in 8%. Falling from height was the most common cause of injury (43%). In addition, 39.1% of the patients were admitted to hospital due to road traffic accidents (Table 2). The laboratory data of the patients on admission were shown in Table 3. Elevated troponin levels were detected in 60.8% of the patients. The mean duration of hospital stay of the patients was 27.2 days. While 90.8% of the 97 patients were discharged with full recovery, 9.2% ( 9 ) of the patients died. Chest trauma was found in 55 (56%) patients. Although there was no statistical difference between the patients with chest trauma and patients who did not have chest trauma in terms of CK and CK-MB, troponin levels were found to be statistically significantly higher in patients with chest trauma (p = 0.011) (Table 4). Electrocardiography was performed in all patients, and sinus tachycardia was detected in 22 (22.6%) patients. Malignant arrhythmia was not detected in any of the patients. Echocardiography was performed in all patients. In only 3 patients, mild pericardial effusion was detected. The mean ejection fraction of the patients was found to be 76.5 ± 2.5%, the mean left ventricular end-diastolic diameter was found to be 39 ± 8.4, and the cardiac functions were found to be within normal limits (Table 5). The mean troponin value of the patients was 1026.06 ± 3889ng/L, and the mean CK-MB value was 35.9 ± 61.7 µg/L. The mean troponin value of the discharged patients was 1093.5 ± 4078ng/L, and the mean troponin value of the patients who died was 371.2 ± 263ng/L, and no statistically significant difference was found between the two groups. In addition, there was no statistically significant difference between the discharged patients and the patients who died in terms of CK and CK-MB values. On computed tomography (CT) of the thorax, it was found that 14 (14.4%) of our patients had lung injury and 2 (2.06%) patients had cardiac injury. While the mean Sequential Organ Failure Assessment Score (SOFA) of the patients who were discharged was 4.94 ± 2.58, the mean SOFA score of the patients who died was found to be statistically higher with 10.78 ± 1.39 (≤ 0.01). In terms of troponin value, no statistical difference was found between patients with a SOFA Score of ≤ 7 and patients with a SOFA score of ≥ 8. Discussion In our study, we present the data of a total of 97 pediatric PT patients admitted to our tertiary emergency department. Epidemiologic studies have revealed that in our country, the most common types of accidents after falls from height are road traffic accidents 3,6 . In our study, 43% of the patients were admitted to the hospital due to falls from height, and this data is consistent with the findings obtained in previous publications. The high rate of falling from height cases is due to the fact that the air temperature is very high in the summer months in our country, especially in the city of Diyarbakir where this study was carried out, and people sleep on the roofs of their houses. Parents need to be careful in terms of their children falling from heights. In the study of Balcı et al., patients with chest trauma were evaluated and the male/female ratio was found to be 6.6 (3649/542) 12 . Similarly, in our study, chest trauma was found to be more common in male patients (male/female ratio: 2). In a study, it was found that 70% of chest traumas were blunt injuries and 30% were penetrating injuries, and it was determined that the most common causes of these traumas were road traffic accidents (75.7%) and falls from height (15.8%) 13 . When the patients who were admitted to our hospital were examined according to the cause of trauma, it was found that 92% had blunt injuries and 8% had penetrating injuries. Evidence on the clinical benefits of the use of cardiac troponins in determining cardiac involvement after chest trauma is limited. Cardiac troponin values measured in 128 patients with chest trauma were found to be elevated in 31% of the patients 14 . Troponin elevation was found in all of our patients with chest trauma. Even if some of these patients had minimal troponin elevation, our study shows the importance of troponin in determining cardiac injury. ECG changes in patients with trauma are nonspecific and do not directly indicate myocardial contusion but are alerting in terms of cardiac involvement and possible complications 15 . Electrocardiography is widely used in the diagnosis of myocardial contusion. In a meta-analysis conducted by Maenza et al., significant cardiac complications were found to be consistent with abnormal ECG findings 16 . Blunt cardiac injuries can cause arrhythmias, and high troponin levels may predict the incidence of arrythmias 17 . Such arrhythmias have been described previously 5 . In our study, abnormal ECG findings were found in 22 of the 97 patients. Sinus tachycardia was detected in all of these 22 patients. No other pathology was found on electrocardiography. Malignant arrhythmias that would require treatment were not detected in any of our patients. Therefore, we could not clearly explain the relationship between chest trauma and arrhythmia in our study. Unlike pulmonary contusion, cardiac contusion in children has been reported to be rare 6,18 ; therefore, the specificity of troponins in determining direct cardiac injury after trauma is questionable. In a large postmortem study, signs of cardiac injury in autopsy were found only in 41 of the 282 children, and most of the patients had died at the scene or soon after admission to hospital 18 . In our study, although high troponin levels were observed in 60.8% of the patients, 9.2% of these patients died. This shows that although troponin levels may indicate cardiac injury, the relationship between troponin levels and mortality is not clear. In the analysis of a study conducted in patients admitted to the pediatric intensive care unit, troponin level proved to be a valuable predictor of mortality at the time of admission 19 . In our study, although troponin levels were found to be higher in patients who died compared to patients who were discharged, no statistically significant difference between the two groups was found. However, troponin values were found to be statistically significantly higher in patients with chest trauma compared to patients who did not have chest trauma. These data show that troponin level can be a valuable marker in the detection of lung contusion and cardiac injury in children and prove the importance of measuring the troponin levels in pediatric patients with chest trauma. The role of ECHO in patients with penetrating heart injury is increasing day by day. Although the role of ECHO in the management of blunt trauma in hemodynamically stable patients is still unclear, it is quite useful for excluding structural problems 20 . Patients with cardiac injuries (rupture or perforation) are at a high risk of death. In clinical series, autopsies performed in patients who died as a result of blunt cardiac trauma have revealed cardiac rupture at a rate of 36%-52%. It is known that patients with cardiac ruptures or perforations often die at the scene or during transport. It has been stated that cardiac rupture may occur in the pericardial cavity, coronary arteries, intrapericardial part of large arteries or veins, and as a result, death may occur secondary to acute cardiac tamponade 21 . In the ECHO results of the patients who were followed up with suspicion of heart injury, abnormal wall motion, regional hypokinesia, right ventricular dilatation, pericardial effusion, ventricular septal defect, ventricular and pericardial contusion were found 22 . In a prospective study, 49 out of 68 patients who were followed up with ECHO, ECG, and CK-MB tests, were found to have abnormal ECHO, ECG, or CK-MB results 23 . On the other hand, in the study conducted by Weiss et al. in 81 patients, no significant correlation was found between ECG changes and ECHO findings 24 . In studies, the diagnostic success rate of ECHO was found to be 67% and it was acknowledged as one of the best diagnostic methods; in addition, it was stated that patients with normal ECHO and ECG results did not require monitoring in the intensive care 24 . In our study, bedside echocardiography was performed in all patients. In only 3 patients, mild pericardial effusion was detected. Other patients had normal echocardiographic findings. Since CK-MB levels increase in skeletal muscle injuries, it is necessary to make a differential diagnosis of patients with skeletal muscle injuries and myocardial injuries. CK-MB is nonspecific in detecting cardiac injury and its role in predicting cardiac contusion and related complications is not clear. In previous studies, it was stated that CK-MB and CK may increase as a normal inflammatory response to injury, and it was determined that CK-MB value increased in most patients with chest trauma 25,26 . In studies conducted on cardiac involvement in trauma patients, CK-MB values were found to be increased and a correlation was found between increased CK-MB values, ECHO and ECG findings and other heart enzyme levels. Therefore, increased CK-MB was reported to be a finding indicating cardiac injury 27,28 . However, some authors reported that no positive correlation was found between CK-MB values and other test results. They stated that CK-MB test may be unnecessary, expensive and clinically confusing in the diagnosis of contusion and should not be used but may be useful in the diagnosis of arrhythmia and cardiac contractile dysfunction 29,30 . In our study, CK-MB and CK values were not found to be statistically significantly higher in children with chest trauma compared to children who did not have chest trauma; therefore, we believe that it cannot be used as a cardiac marker as stated in some previous studies. Serum troponin value has a high specificity for myocardial contusion. Troponins are released into the blood as a result of loss of myocyte membrane integrity; they are proteins that regulate myocardial contraction and are not secreted from skeletal muscles. In the literature, it has been stated that troponin has a high sensitivity and specificity for the diagnosis of cardiac injury, that it has a higher sensitivity than other markers and may be more valuable than CK-MB in the diagnosis 27,31 . However, in an animal study conducted by Bertinchant et al., it was stated that myocardial contusion could not be diagnosed based on the troponin level alone; and in the study of Mair et al., it was reported that no relationship was found between troponin elevation and ECG changes 32 . In our study, although ECG findings were very rare in the patients (sinus tachycardia was detected in 22% of the patients), troponin elevation was found in all patients with sinus tachycardia. This shows the importance of measuring troponin levels and performing ECG and ECHO, especially in children with chest trauma, for the diagnosis of cardiac involvement. Cardiac injuries are life-threatening problems in patients with polytrauma, especially chest trauma. However, the actual incidence of cardiac injuries is unknown, since there are no definitive criteria for the diagnosis of cardiac injuries in trauma patients. Electrocardiography is considered to be a sensitive test in the diagnosis of blunt heart injuries. In this regard, all heart rhythm disorders should be carefully evaluated in order not to miss any injury. Evaluation of troponin levels is important in terms of detecting increased risk of death, especially in patients with abnormal ECG results. Among patients presenting with blunt chest trauma, those with a history of cardiac disease, those who are hemodynamically unstable, those with abnormal ECG results, high troponin and CK-MB levels and high trauma severity scores should be followed up with appropriate cardiac monitoring. In addition, patients presenting with chest pain, rib and sternal fractures and lung injuries as a result of blunt chest trauma should be kept under observation for at least 24 hours in terms of blunt heart injury. In order to predict cardiac injury in pediatric patients with chest trauma, electrocardiography should be performed, and CK-MB and troponin levels should be measured. To detect and treat life-threatening injuries such as pericardial tamponade early, echocardiography should also be performed. Limitations of the Study Since no malignant arrhythmia was detected in the patients included in our study, we were not able to present our opinion on arrhythmias that were reported in patients with blunt chest trauma in previous studies. Declarations Acknowledgements: None. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Disclosure: The authors declare no conflict of interest. Author Contributions: M.Y, M.S, A.A, M.T designed the study, M.T, D.U,A.Ş and M.M.T wrote this manuscript, M.Y and M.M.T gave conceptual advice, A.A, M.S,A.Ş and D.U collected and analyzed the data. All authors read and approved the final manuscript. Ethics approval Approval for the study was obtained from the Ethics Committee of our hospital (Approval date: 15.02.2022 / Approval number: 76). Consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors have no relevant fnancial or nonfinancial interests to disclose. References Battistella FD, Benfield JR (2000) Blunt and penetrating injüries of the chest wall, pleura and lungs. Shield Tw. General thoracic surgery, 5nd edn. Williams and wilkins, Philadelphia, pp 815–863 Locicero I, Mattox KL (1989) Epidemiology of chest trauma. Surg Clin North Am 69:15–19 Tovar JA, Vazquez JJ (2013) Management of chest trauma in children.Paediatr Respir Rev. 14:86–91 Bliss D, Silen M (2002) Pediatric thoracic trauma. Crit Care Med 30:S409–415 Tegethoff AM, Raney E, Mendelson J, Minckler MR (2017) Paediatric chest Wall trauma causing delayed presentation of ventricular arrhythmia. BMJ Case Rep 2017:bcr–2017 Dowd MD, Krug S (1996) Pediatric blunt cardiac injury: epidemiology, clinical features, and diagnosis. Pediatric Emergency Medicine Collaborative Research Committee: Working Group on Blunt Cardiac Injury. J Trauma 40:61–67 Kalbitz M, Pressmar J, Stecher J, Weber B, Weiss M, Schwarz S et al (2016) The role of troponin in blunt cardiac injury after multiple trauma in humans. World J Surg 41:162–169 Mahajan VS, Jarolim P (2011) How to interpret elevated cardiac troponin levels. Circulation 124:2350–2354 Cervellin G, Lippi G (2014) Of MIs and men – a historical per spective on the diagnostics of acute myocardial infarc tion. Semin Thromb Hemost 40:535–543 Bertinchant JP, Polge A, Mohty D, Nguyen-Ngoc-Lam R, Estorc J, Cohendy R et al (2000) 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 48:924–931 Bian F, Wu Y-E, Zhang C-L (2017) Variation in the levels of IL-6 in pediatric patients with severe bacterial infectious diseases and correlation analysis between the levels of IL-6 and procalcitonin. Exp Ther Med 13:3484–3488 Balcı AE, Eren N, Eren Ş, Ülkü R, Onat S, Cebeci E (2001) Travma Torakotomilerinde Mortaliteyi Etkileyen Faktörler. Türk Göğüs Kalp Damar Cerrahisi Dergisi 9(4):215–220 Tekinbaş C, Eroğlu A, Kürkçüoğlu IC, Türkyılmaz A, Yekeler E, Karanoğlu N (2003) Chest Trauma: Analist of 592 cases. Ulus Travma Dergisi, ;(4):275–280 Ferjani M, Droc G, Dreux S, Arthaud M, Goarin JP, Riou B et al (1997) Circulating cardiac troponin T in myocardial con tusion. Chest 111:427–433 Potkin RT, Werner JA, Trobaugh GB (1982) Evaluation of noninvaziv tests of cardiac damage in suspect cardiac contusion. Circulation 66:627–631 Schick TD, Van der Zee H, Powers SR (1977) Detection of cardiac disturbances following thoracic trauma with high-frequency analysis of the electrocardiogram. J Trauma 17:419–424 Rajan GP, Zellweger R (2004) Cardiac troponin I as a predictor of arrhythmia and ventricular dysfunction in trauma patients with myocardial contusion. J Trauma 57:808 discussion 808 Scorpio RJ, Wesson DE, Smith CR, Hu X, Spence LJ (1996) Blunt cardiac injuries in children: a postmortem study. J Trauma 41:306–309 Wilson C, Sambandamoorthy G, Holloway P, Ramnarayan P, Inwald DP (2016) Admission plasma troponin I is associated with mortality in pediatric intensive care. Pediatr Crit Care Med 17:831–836 Kapadıa SR, Topol EJ (2005) Kardiak Travma. Topol EJ. Textbook of cardiovaskular medicine, 1st edn. Cordisgroup, Ohio, pp 901–915 Fitzgerald M, Spencer J, Johnson F, Marasco S, Atkin C, Kossmann T (2005) Definitive management of acute cardiac tamponade secondary to blunt trauma. Emerg Med Australas, Oct-Dec;17(5–6):494–499 Meyer DM, Jessen ME, Grayburn PA (1995) Use of Echocardiography to Detect Occult Cardiac Injury After Penetrating 37 Thoracic Trauma: A Prospective Study. J Trauma, ; 39 – 5: 902–907 Helling TS, Duke P, Beggs CW, Crouse LJ (1989) A prospective evaluation of 68 patients suffering blunt chest trauma for evidence of cardiac injury. J Trauma 29(7):961–965 Hiatt JR, Yeatman LA Jr, Child JS (1988) The value of echocardiography in blunt chest trauma. J Trauma 28(7):914–922 Christensen MA, Sutton KR (1993) Myocardial contusion: new concepts in diagnosis and management. Am J Crit Care 2:28–34 Hackl JM, Puschendorf B, Dienstl F, Dworzak E, Haid B The value of CKMB in multiple trauma and high voltage injuries. Infusionsther Klin Ernahr 19785(4):204–207 Fulda GJ, Giberson F, Hailstone D (1997) An evaluation of serum troponin T and signal averaged electrocardiography in predicting electrocardiographic abnormalities after blunt chest trauma. J Trauma 43:308–311 Kettunen P (1985) Creatine kinase MB and M-mode echocardiographic changes in cardiac contusion. Ann Clin Research 17:292–298 Mair P, Mair J, Koller J, Wieser C, Talaszand H, Puschendorf B (1995) Cardiac troponin T release in multiply injured patients. Injury 26(7):439–443 Okubo NMD, Hombrouck CP, Fornes PMD (2000) Cardiac troponin I and miyocardial contusion in the rabbit. Anesthesiology 93:811–817 Ferjani M (1997) Circulating cardiac troponin T in myocardial contusion. Chest 111:427–433 Damas P, Reuter CA, Gysen P (1989) Tumor necrosis factor and interleukin 1 serum levels during severe sepsis in humans. Crit- Care-Med 17:975–978 Tables Tables 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3866204","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":267489759,"identity":"80fd0f25-0fc5-4785-a78f-aff8d6cf80ce","order_by":0,"name":"Mahmut Yaman","email":"","orcid":"","institution":"Dicle University Faculty of Medicine, Department of Emergency of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mahmut","middleName":"","lastName":"Yaman","suffix":""},{"id":267489760,"identity":"807ff871-7213-4799-9ad6-e15234e1f1f1","order_by":1,"name":"Mehmet TÜRE","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYDCCA2DShocfRCUUEKWFGUSmyUg2gLQYEK/lsI0B2DpitPDdPn9MuqKCmcf4/OrEDw8MGOT5xQ7g1yJ5LplN8swZNh6zG283SwAdZjhzdgJ+LQZnmNkkG9t4gFrObgBpSTC4TZSWfxI8xjPObv5BgpYGAx4D/t5txNkieYbZ2LLhWAKPxA3ebRYJBhKE/cJ3hvHhzYaa//b8/Wc33/xRYSPPL01ACwJIgFVKEKscBPgPkKJ6FIyCUTAKRhIAANEOQNL5+XUgAAAAAElFTkSuQmCC","orcid":"","institution":"Dicle University Faculty of Medicine, Department of Pediatric Cardiology","correspondingAuthor":true,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"TÜRE","suffix":""},{"id":267489761,"identity":"73b3c9d3-e5da-4497-8db5-4861a3960c9a","order_by":2,"name":"Alper AKIN","email":"","orcid":"","institution":"Dicle University Faculty of Medicine, Department of Pediatric Cardiology","correspondingAuthor":false,"prefix":"","firstName":"Alper","middleName":"","lastName":"AKIN","suffix":""},{"id":267489762,"identity":"77e60ebe-ba7d-4bea-adef-be71d193801e","order_by":3,"name":"Duygu UÇ","email":"","orcid":"","institution":"Dicle University Faculty of Medicine, Department of Pediatric Cardiology","correspondingAuthor":false,"prefix":"","firstName":"Duygu","middleName":"","lastName":"UÇ","suffix":""},{"id":267489763,"identity":"c48f705f-205c-43ba-b891-77b40b2be5bb","order_by":4,"name":"Mehmet Sürücü","email":"","orcid":"","institution":"Dicle University Faculty of Medicine, Department of Pediatric Cardiology","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"Sürücü","suffix":""},{"id":267489764,"identity":"ccd6d6ba-ad62-4bc0-be69-7c99bb2794e2","order_by":5,"name":"Abdullah Şen","email":"","orcid":"","institution":"Dicle University Faculty of Medicine, Department of Emergency of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Abdullah","middleName":"","lastName":"Şen","suffix":""}],"badges":[],"createdAt":"2024-01-15 10:44:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3866204/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3866204/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49765869,"identity":"8aad9954-718e-4b5e-bd63-93350cbd0a95","added_by":"auto","created_at":"2024-01-17 16:52:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":220738,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3866204/v1/b325a211-773a-4808-beb5-6bfba3dc976a.pdf"},{"id":49742466,"identity":"fc9ea6ec-249c-444d-b9d3-fc7c3eb6daac","added_by":"auto","created_at":"2024-01-17 09:44:05","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16730,"visible":true,"origin":"","legend":"","description":"","filename":"TraumaTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-3866204/v1/1654fa8cdf2113cdde0fccbc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cardiac Evaluation of Children Presenting with Trauma","fulltext":[{"header":"What Is Known","content":"\u003cp\u003eIn previous studies, cardiac involvement due to trauma was evaluated in adults. In our literature review, we found only one article on this subject in children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat is New:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings reveal the prognostic value of cardiac troponins in terms of direct or indirect impact on the heart, especially in pediatric patients with chest trauma. We think that our article will make a great contribution to the literature, since there is no other study reaching these results.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eTrauma is a major public health issue and one of the most important causes of death, especially because it affects the young age group and causes financial and moral loss (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is known that in 1/3 of trauma patients, severe chest trauma is the cause of hospitalization, and 20\u0026ndash;25% of deaths occur due to chest trauma\u003csup\u003e1,2\u003c/sup\u003e. In children, the rib cage is more flexible than adults, making them more prone to thoracic injuries\u003csup\u003e3\u003c/sup\u003e. Lung contusion may lead to impaired gas exchange followed by hypoxemia, often without evident external signs of injury\u003csup\u003e4\u003c/sup\u003e. In addition, blunt cardiac injuries in children have been reported to cause significant arrhythmias\u003csup\u003e5\u003c/sup\u003e and even prolonged cardiac dysfunction\u003csup\u003e6\u003c/sup\u003e. Cardiomyocyte injury is determined by evaluating cardiac troponin levels and electrocardiography (ECG) and echocardiography (ECHO) results\u003csup\u003e7\u003c/sup\u003e. Cardiac troponins are considered to be the most sensitive and specific biomarkers for the diagnosis of cardiomyocyte injury. As in other mechanisms, these biomarkers are released into the circulation in the presence of myocardial or cardiomyocyte injury, providing meaningful results for acute cardiac ischemia\u003csup\u003e8,9\u003c/sup\u003e. Elevated plasma levels of cardiac troponin in polytrauma patients are associated with the severity of injury and mortality\u003csup\u003e7\u003c/sup\u003e ; however, their predictive value for cardiac injury is still being discussed\u003csup\u003e10\u003c/sup\u003e. In terms of pediatric PT, little is known about the importance of troponin assessment in the emergency department and its role in predicting outcome-related endpoints\u003csup\u003e11\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe aim of this study is to determine the predictive value of troponin, which is used as a biomarker of cardiac injury in practice in pediatric patients admitted to the emergency department due to trauma, and the effect of cardiac evaluation of patients on prognosis.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eIn this study, 97 patients aged 0\u0026ndash;18 years, who were admitted to the emergency department of our hospital between January 2015 and January 2022 due to trauma, were included. Sociodemographic characteristics of the patients (age, gender), the cause and severity of the trauma, sequential organ failure assessment score (SOFA), patient progression, electrocardiography and echocardiography results, laboratory data (biochemical, hemogram, C-reactive protein, pro-BNP, CK-MB, troponin, etc.) were evaluated retrospectively. Patients with a medical history of cardiac disease were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis of the data was performed using SPSS 24 (SPSS Inc., Chicago, Illinois) software. The conformity of the variables to normal distribution was examined using visual (histogram and probability plots) and analytical methods (Kolmogorov-Smirnov/Shapiro-Wilk tests). Descriptive statistics were expressed as median for non-normally distributed variables and as mean for normally distributed variables. For the relationships between variables, at least one of which was non-normally distributed or ordinal, correlation coefficients and statistical significance were calculated using the Spearman\u0026rsquo;s Rank Correlation or Pearson's Correlation Coefficient. In the comparison of quantitative variables between the two groups, the Student\u0026rsquo;s T-test or Mann-Whitney U test was used. The Chi-square test was used to compare categorical variables. Statistical significance level (bidirectional) was chosen as α\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 97 trauma patients, 32 (33%) female and 65 (67%) male, were included in the study. The mean age and standard deviation score of the female patients were found as 150\u0026thinsp;\u0026plusmn;\u0026thinsp;55.1 months, and the mean age and standard deviation score of the male patients were found as 100.5\u0026thinsp;\u0026plusmn;\u0026thinsp;63.1 (Table\u0026nbsp;1). When the patients were examined according to the trauma mechanisms, blunt injuries were found in 92% and penetrating injuries were found in 8%. Falling from height was the most common cause of injury (43%). In addition, 39.1% of the patients were admitted to hospital due to road traffic accidents (Table\u0026nbsp;2). The laboratory data of the patients on admission were shown in Table\u0026nbsp;3. Elevated troponin levels were detected in 60.8% of the patients. The mean duration of hospital stay of the patients was 27.2 days. While 90.8% of the 97 patients were discharged with full recovery, 9.2% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) of the patients died. Chest trauma was found in 55 (56%) patients. Although there was no statistical difference between the patients with chest trauma and patients who did not have chest trauma in terms of CK and CK-MB, troponin levels were found to be statistically significantly higher in patients with chest trauma (p\u0026thinsp;=\u0026thinsp;0.011) (Table\u0026nbsp;4). Electrocardiography was performed in all patients, and sinus tachycardia was detected in 22 (22.6%) patients. Malignant arrhythmia was not detected in any of the patients. Echocardiography was performed in all patients. In only 3 patients, mild pericardial effusion was detected. The mean ejection fraction of the patients was found to be 76.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5%, the mean left ventricular end-diastolic diameter was found to be 39\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4, and the cardiac functions were found to be within normal limits (Table\u0026nbsp;5).\u003c/p\u003e \u003cp\u003eThe mean troponin value of the patients was 1026.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3889ng/L, and the mean CK-MB value was 35.9\u0026thinsp;\u0026plusmn;\u0026thinsp;61.7 \u0026micro;g/L. The mean troponin value of the discharged patients was 1093.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4078ng/L, and the mean troponin value of the patients who died was 371.2\u0026thinsp;\u0026plusmn;\u0026thinsp;263ng/L, and no statistically significant difference was found between the two groups. In addition, there was no statistically significant difference between the discharged patients and the patients who died in terms of CK and CK-MB values.\u003c/p\u003e \u003cp\u003eOn computed tomography (CT) of the thorax, it was found that 14 (14.4%) of our patients had lung injury and 2 (2.06%) patients had cardiac injury. While the mean Sequential Organ Failure Assessment Score (SOFA) of the patients who were discharged was 4.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58, the mean SOFA score of the patients who died was found to be statistically higher with 10.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39 (\u0026le;\u0026thinsp;0.01). In terms of troponin value, no statistical difference was found between patients with a SOFA Score of \u0026le;\u0026thinsp;7 and patients with a SOFA score of \u0026ge;\u0026thinsp;8.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, we present the data of a total of 97 pediatric PT patients admitted to our tertiary emergency department. Epidemiologic studies have revealed that in our country, the most common types of accidents after falls from height are road traffic accidents\u003csup\u003e3,6\u003c/sup\u003e. In our study, 43% of the patients were admitted to the hospital due to falls from height, and this data is consistent with the findings obtained in previous publications. The high rate of falling from height cases is due to the fact that the air temperature is very high in the summer months in our country, especially in the city of Diyarbakir where this study was carried out, and people sleep on the roofs of their houses. Parents need to be careful in terms of their children falling from heights.\u003c/p\u003e \u003cp\u003eIn the study of Balcı et al., patients with chest trauma were evaluated and the male/female ratio was found to be 6.6 (3649/542)\u003csup\u003e12\u003c/sup\u003e. Similarly, in our study, chest trauma was found to be more common in male patients (male/female ratio: 2).\u003c/p\u003e \u003cp\u003eIn a study, it was found that 70% of chest traumas were blunt injuries and 30% were penetrating injuries, and it was determined that the most common causes of these traumas were road traffic accidents (75.7%) and falls from height (15.8%)\u003csup\u003e13\u003c/sup\u003e. When the patients who were admitted to our hospital were examined according to the cause of trauma, it was found that 92% had blunt injuries and 8% had penetrating injuries.\u003c/p\u003e \u003cp\u003eEvidence on the clinical benefits of the use of cardiac troponins in determining cardiac involvement after chest trauma is limited. Cardiac troponin values measured in 128 patients with chest trauma were found to be elevated in 31% of the patients\u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTroponin elevation was found in all of our patients with chest trauma. Even if some of these patients had minimal troponin elevation, our study shows the importance of troponin in determining cardiac injury.\u003c/p\u003e \u003cp\u003eECG changes in patients with trauma are nonspecific and do not directly indicate myocardial contusion but are alerting in terms of cardiac involvement and possible complications\u003csup\u003e15\u003c/sup\u003e. Electrocardiography is widely used in the diagnosis of myocardial contusion. In a meta-analysis conducted by Maenza et al., significant cardiac complications were found to be consistent with abnormal ECG findings\u003csup\u003e16\u003c/sup\u003e. Blunt cardiac injuries can cause arrhythmias, and high troponin levels may predict the incidence of arrythmias\u003csup\u003e17\u003c/sup\u003e. Such arrhythmias have been described previously\u003csup\u003e5\u003c/sup\u003e. In our study, abnormal ECG findings were found in 22 of the 97 patients. Sinus tachycardia was detected in all of these 22 patients. No other pathology was found on electrocardiography. Malignant arrhythmias that would require treatment were not detected in any of our patients. Therefore, we could not clearly explain the relationship between chest trauma and arrhythmia in our study.\u003c/p\u003e \u003cp\u003eUnlike pulmonary contusion, cardiac contusion in children has been reported to be rare\u003csup\u003e6,18\u003c/sup\u003e; therefore, the specificity of troponins in determining direct cardiac injury after trauma is questionable. In a large postmortem study, signs of cardiac injury in autopsy were found only in 41 of the 282 children, and most of the patients had died at the scene or soon after admission to hospital\u003csup\u003e18\u003c/sup\u003e. In our study, although high troponin levels were observed in 60.8% of the patients, 9.2% of these patients died. This shows that although troponin levels may indicate cardiac injury, the relationship between troponin levels and mortality is not clear. In the analysis of a study conducted in patients admitted to the pediatric intensive care unit, troponin level proved to be a valuable predictor of mortality at the time of admission\u003csup\u003e19\u003c/sup\u003e. In our study, although troponin levels were found to be higher in patients who died compared to patients who were discharged, no statistically significant difference between the two groups was found. However, troponin values were found to be statistically significantly higher in patients with chest trauma compared to patients who did not have chest trauma. These data show that troponin level can be a valuable marker in the detection of lung contusion and cardiac injury in children and prove the importance of measuring the troponin levels in pediatric patients with chest trauma.\u003c/p\u003e \u003cp\u003eThe role of ECHO in patients with penetrating heart injury is increasing day by day. Although the role of ECHO in the management of blunt trauma in hemodynamically stable patients is still unclear, it is quite useful for excluding structural problems\u003csup\u003e20\u003c/sup\u003e. Patients with cardiac injuries (rupture or perforation) are at a high risk of death. In clinical series, autopsies performed in patients who died as a result of blunt cardiac trauma have revealed cardiac rupture at a rate of 36%-52%. It is known that patients with cardiac ruptures or perforations often die at the scene or during transport. It has been stated that cardiac rupture may occur in the pericardial cavity, coronary arteries, intrapericardial part of large arteries or veins, and as a result, death may occur secondary to acute cardiac tamponade\u003csup\u003e21\u003c/sup\u003e. In the ECHO results of the patients who were followed up with suspicion of heart injury, abnormal wall motion, regional hypokinesia, right ventricular dilatation, pericardial effusion, ventricular septal defect, ventricular and pericardial contusion were found\u003csup\u003e22\u003c/sup\u003e. In a prospective study, 49 out of 68 patients who were followed up with ECHO, ECG, and CK-MB tests, were found to have abnormal ECHO, ECG, or CK-MB results\u003csup\u003e23\u003c/sup\u003e. On the other hand, in the study conducted by Weiss et al. in 81 patients, no significant correlation was found between ECG changes and ECHO findings\u003csup\u003e24\u003c/sup\u003e. In studies, the diagnostic success rate of ECHO was found to be 67% and it was acknowledged as one of the best diagnostic methods; in addition, it was stated that patients with normal ECHO and ECG results did not require monitoring in the intensive care\u003csup\u003e24\u003c/sup\u003e. In our study, bedside echocardiography was performed in all patients. In only 3 patients, mild pericardial effusion was detected. Other patients had normal echocardiographic findings.\u003c/p\u003e \u003cp\u003eSince CK-MB levels increase in skeletal muscle injuries, it is necessary to make a differential diagnosis of patients with skeletal muscle injuries and myocardial injuries. CK-MB is nonspecific in detecting cardiac injury and its role in predicting cardiac contusion and related complications is not clear. In previous studies, it was stated that CK-MB and CK may increase as a normal inflammatory response to injury, and it was determined that CK-MB value increased in most patients with chest trauma\u003csup\u003e25,26\u003c/sup\u003e. In studies conducted on cardiac involvement in trauma patients, CK-MB values were found to be increased and a correlation was found between increased CK-MB values, ECHO and ECG findings and other heart enzyme levels. Therefore, increased CK-MB was reported to be a finding indicating cardiac injury\u003csup\u003e27,28\u003c/sup\u003e. However, some authors reported that no positive correlation was found between CK-MB values and other test results. They stated that CK-MB test may be unnecessary, expensive and clinically confusing in the diagnosis of contusion and should not be used but may be useful in the diagnosis of arrhythmia and cardiac contractile dysfunction\u003csup\u003e29,30\u003c/sup\u003e. In our study, CK-MB and CK values were not found to be statistically significantly higher in children with chest trauma compared to children who did not have chest trauma; therefore, we believe that it cannot be used as a cardiac marker as stated in some previous studies.\u003c/p\u003e \u003cp\u003eSerum troponin value has a high specificity for myocardial contusion. Troponins are released into the blood as a result of loss of myocyte membrane integrity; they are proteins that regulate myocardial contraction and are not secreted from skeletal muscles. In the literature, it has been stated that troponin has a high sensitivity and specificity for the diagnosis of cardiac injury, that it has a higher sensitivity than other markers and may be more valuable than CK-MB in the diagnosis\u003csup\u003e27,31\u003c/sup\u003e. However, in an animal study conducted by Bertinchant et al., it was stated that myocardial contusion could not be diagnosed based on the troponin level alone; and in the study of Mair et al., it was reported that no relationship was found between troponin elevation and ECG changes\u003csup\u003e32\u003c/sup\u003e. In our study, although ECG findings were very rare in the patients (sinus tachycardia was detected in 22% of the patients), troponin elevation was found in all patients with sinus tachycardia. This shows the importance of measuring troponin levels and performing ECG and ECHO, especially in children with chest trauma, for the diagnosis of cardiac involvement.\u003c/p\u003e \u003cp\u003eCardiac injuries are life-threatening problems in patients with polytrauma, especially chest trauma. However, the actual incidence of cardiac injuries is unknown, since there are no definitive criteria for the diagnosis of cardiac injuries in trauma patients. Electrocardiography is considered to be a sensitive test in the diagnosis of blunt heart injuries. In this regard, all heart rhythm disorders should be carefully evaluated in order not to miss any injury. Evaluation of troponin levels is important in terms of detecting increased risk of death, especially in patients with abnormal ECG results. Among patients presenting with blunt chest trauma, those with a history of cardiac disease, those who are hemodynamically unstable, those with abnormal ECG results, high troponin and CK-MB levels and high trauma severity scores should be followed up with appropriate cardiac monitoring. In addition, patients presenting with chest pain, rib and sternal fractures and lung injuries as a result of blunt chest trauma should be kept under observation for at least 24 hours in terms of blunt heart injury.\u003c/p\u003e \u003cp\u003eIn order to predict cardiac injury in pediatric patients with chest trauma, electrocardiography should be performed, and CK-MB and troponin levels should be measured. To detect and treat life-threatening injuries such as pericardial tamponade early, echocardiography should also be performed.\u003c/p\u003e"},{"header":"Limitations of the Study","content":"\u003cp\u003eSince no malignant arrhythmia was detected in the patients included in our study, we were not able to present our opinion on arrhythmias that were reported in patients with blunt chest trauma in previous studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e M.Y, M.S, A.A, M.T designed the study, M.T, D.U,A.Ş and M.M.T wrote this manuscript, M.Y and M.M.T gave conceptual advice, A.A, M.S,A.Ş and D.U collected and analyzed the data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e Approval for the study was obtained from the Ethics Committee of our hospital (Approval date: 15.02.2022 / Approval number: 76).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors have no relevant fnancial or nonfinancial interests to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBattistella FD, Benfield JR (2000) Blunt and penetrating inj\u0026uuml;ries of the chest wall, pleura and lungs. Shield Tw. General thoracic surgery, 5nd edn. Williams and wilkins, Philadelphia, pp 815\u0026ndash;863\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLocicero I, Mattox KL (1989) Epidemiology of chest trauma. Surg Clin North Am 69:15\u0026ndash;19\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTovar JA, Vazquez JJ (2013) Management of chest trauma in children.Paediatr Respir Rev. 14:86\u0026ndash;91\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBliss D, Silen M (2002) Pediatric thoracic trauma. Crit Care Med 30:S409\u0026ndash;415\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTegethoff AM, Raney E, Mendelson J, Minckler MR (2017) Paediatric chest Wall trauma causing delayed presentation of ventricular arrhythmia. BMJ Case Rep 2017:bcr\u0026ndash;2017\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDowd MD, Krug S (1996) Pediatric blunt cardiac injury: epidemiology, clinical features, and diagnosis. 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Infusionsther Klin Ernahr 19785(4):204\u0026ndash;207\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFulda GJ, Giberson F, Hailstone D (1997) An evaluation of serum troponin T and signal averaged electrocardiography in predicting electrocardiographic abnormalities after blunt chest trauma. J Trauma 43:308\u0026ndash;311\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKettunen P (1985) Creatine kinase MB and M-mode echocardiographic changes in cardiac contusion. Ann Clin Research 17:292\u0026ndash;298\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMair P, Mair J, Koller J, Wieser C, Talaszand H, Puschendorf B (1995) Cardiac troponin T release in multiply injured patients. Injury 26(7):439\u0026ndash;443\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkubo NMD, Hombrouck CP, Fornes PMD (2000) Cardiac troponin I and miyocardial contusion in the rabbit. Anesthesiology 93:811\u0026ndash;817\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerjani M (1997) Circulating cardiac troponin T in myocardial contusion. Chest 111:427\u0026ndash;433\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDamas P, Reuter CA, Gysen P (1989) Tumor necrosis factor and interleukin 1 serum levels during severe sepsis in humans. Crit- Care-Med 17:975\u0026ndash;978\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Trauma, troponin, children, prognosis","lastPublishedDoi":"10.21203/rs.3.rs-3866204/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3866204/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eElevated plasma levels of cardiac troponin in polytrauma patients may be associated with the severity of injury and mortality.\u003c/p\u003e\n\u003cp\u003eIn this study, we aimed to determine the predictive value of troponin and the effect of cardiac evaluations on prognosis in pediatric patients admitted to the emergency department due to trauma.\u003c/p\u003e\n\u003cp\u003eIn the study, 97 patients aged 0-18 years who presented with trauma were included. The cause and severity of the trauma, electrocardiography and echocardiography results, and laboratory data (biochemical, hemogram, C-reactive protein, pro-BNP, CK-MB, troponin, etc.) of the patients were evaluated.\u003c/p\u003e\n\u003cp\u003eFalling from height was the most common cause of injury (43%). In 55 (56%) patients, chest trauma was found. Troponin elevation was present in all patients with chest trauma. Troponin levels were found to be statistically significantly higher in patients with chest trauma compared to those who did not have chest trauma (p=0.011). While the mean Sequential Organ Failure Assessment Score (SOFA) of the patients who were discharged was 4.94±2.58, the mean SOFA score of the patients who died was found to be statistically higher with 10.78±1.39 (≤0.01).\u003c/p\u003e\n\u003cp\u003eOur findings have revealed the prognostic value of cardiac troponins in terms of direct or indirect injury to the heart, especially in pediatric patients with chest trauma. Therefore, in children presenting with chest trauma, determining the cardiac injury by evaluating the electrocardiography results, which can be easily accessed in every health center, and cardiac troponins may be a guide in terms of patient prognosis.\u003c/p\u003e","manuscriptTitle":"Cardiac Evaluation of Children Presenting with Trauma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-17 09:44:00","doi":"10.21203/rs.3.rs-3866204/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c58d7090-36a1-4e22-b436-4c47b3cc60d5","owner":[],"postedDate":"January 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-17T16:44:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-17 09:44:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3866204","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3866204","identity":"rs-3866204","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}