Screening for by cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma 73:(5) Supplement 4, S301-S306, 2012.
Michael McGonigal has a great summary of the BCI guidelines on his Trauma Professional's Blog
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Scott Weingart
An ED Intensivist from NY. No conflicts of interest (coi).
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Hey Scott-
At Level 2- they state:
“In patients with a normal ECG result and normal troponin I level, BCI is ruled out. The optimal timing of these measurements, however, has yet to be determined.”
I don’t know of any good evidence on how quickly trops rise after BCI but I suspect it takes some time as it does in MI to be reasonably sensitive. They acknowledge that the timing is “yet to be determined”.
Also Level 2: “The presence of a sternal fracture alone does not predict the presence of BCI and thus should not prompt monitoring in the setting of normal ECG result and troponin I level (moved from Level 3).”
Same problem; to me– based on the timing issue, one immediate NEG troponin doesn’t seem very helpful, and thus these recommendations using a negative troponin don’t appear to have much value.
I think it’s probably worthwhile to get since if it’s positive you can act on that– and an initial negative trop is probably a somewhat useful screen.
I definitely don’t wanna see a day where they are recommending a 2 set rule out for this!