Myocardial contusion: new concepts in diagnosis and management.

Myocardial contusion is diagnosed with one or a combination of four diagnostic procedures: electrocardiography, echocardiography, creatine kinase MB fractions and/or radionuclide procedures. This article presents a critical review of 18 recent studies addressing the utility, sensitivity and specificity of these tests. Careful review suggests that clinically significant myocardial contusions as a result of blunt trauma are rare and may be detected simply and inexpensively using electrocardiography and careful physical examination. Serum myocardial enzymes and radionuclide studies are nonspecific and are not predictive of cardiac complications. Echocardiography is useful in the management of myocardial decompensation but not as a primary screening tool in blunt cardiac injury. Cost comparisons, resource allocation and implications for critical care practice are discussed.