Co esponding au ho : Mazi Mohammed Alanazi.
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Blun ches auma associa ed ca diac inju y diagnosis in he eme gency depa men :
A sys ema ic e iew
Mazi Mohammed Alanazi 1, *, Raghad A. Alib ahim 2 and Rawan Saad M Alshah ani 3
1 Saudi and Jo danian Boa d Eme gency Medicine, Head o Eme gency Resea ch Uni , Eme gency Depa men , Fi s Heal h
Clus e , Riyadh, Saudi A abia.
2 Saudi boa d eme gency medicine esiden , Asee Cen al Hospi al, Abha, Saudi A abia.
3 Saudi boa d eme gency medicine esiden s, A med o ces hospi al sou he n egion (AFHSR), Khamis Mushay , Saudi
A abia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2251-2257
Publica ion his o y: Recei ed on 02 Ap il 2025; e ised on 11 May 2025; accep ed on 13 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1881
Abs ac
Backg ound: Diagnosing ca diac con usions om o ce ul ches auma is s ill di icul due o he non-speci ic
symp oms i p oduces and he absence o eliable diagnos ics o iden i y myoca dial damage. This s udy's aim o assess
how well diagnos ic echniques iden i y blun hea damage and i s consequences.
Me hod: PRISMA c i e ia we e ollowed in he conduc o his sys ema ic e iew s udy. Two e iewe s sea ched he
MEDLINE, Scopus, and Embase da abases o loca e ele an wo ks om 2014 o 2024. The sea ch was limi ed o
publica ions w i en in English. We conside ed case se ies, obse a ional s udies, and p ospec i e o e ospec i e
coho s udies ha look a ways o diagnose blun ca diac damage. S udies ha e alua e bioma ke -based diagnos ics
o imaging modali ies. We inco po a e esea ch ha epo s on he diagnos ic modali ies' sensi i i y, speci ici y, and
accu acy. Resea ch assessing he clinical esul s o using hese diagnos ic ins umen s.
Resul and conclusion: The complexi y o BCI diagnosis and ea men indica ed he necessi y o an all-encompassing
diagnos ic s a egy. Al hough CMR and DECT p o ide excellen diagnos ic accu acy, hey a e occasionally unsui able in
si ua ions in ol ing se e e auma. TEE has become a e y use ul bedside echnique, pa icula ly o pa ien s who a e
uns able. T oponins and ECG a e sc eening es s ha can be used o ule ou BCI because o hei mode a e sensi i i y
and high speci ici y.
Keywo ds: Blun Ches T auma; Diagnosis; Myoca dial Con usions; Eme gency Depa men
1. In oduc ion
Fi een pe cen o eme gency depa men admissions globally a e due o blun ches inju ies (BCI), which a e linked o
high a es o mo bidi y and dea h (El-Chami e al. 2008; FRAZEE e al. 1986; an Wijngaa den e al. 1997). They migh
happen a e a ca c ash, a all om a heigh , a iolen a ack, o an inju y sus ained in spo s. Decele a ing o ces applied
on he an e io po ion o he ches wall a e belie ed o be he cause o he damage o he hea , which pu s he hea 's
iscoelas ic quali ies o he es (FRAZEE e al. 1986). Following he impac , he hea is ee o a el along he an e io -
pos e io axis o he ho acic ca i y. I may hen be c ushed jus agains he pos e io o he s e num o , in he case o a
mo e o ce ul impac , "squashed" be ween he s e num and he an e io aspec o he ho acic spine.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2251-2257
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I is clea ha he clinical appea ance o indi iduals wi h BCI a ies widely since hese inju ies include a wide ange o
causes and in ensi ies. A silen clinical inding o a ying physiological ins abili y deg ees a e possible p esen a ions,
bu in some cases, inju ies o key s uc u es like he pe ica dium, al es, cho dae endinae, papilla y muscle, co ona y
a e y, o en icula sep um may be "ca as ophic" (El-Chami e al. 2008; FRAZEE e al. 1986; Sade e al. 2017).
The wo ds "ca diac con usion" and "BCI" a e equen ly used in e changeably in he li e a u e. The ph ase myoca dial
con usion should no longe be used as a diagnos ic o admission o a ing o inju y se e i y (andNA; 1992). This s udy's
main goal is o assess how well diagnos ic echniques iden i y blun hea damage and i s consequences.
2. Me hod
This sys ema ic e iew s udy was conduc ed acco ding o PRISMA guidelines. To ind pe inen pape s om 2014 o
2024, wo independen e iewe s examined he MEDLINE, Scopus and Embase da abases. Only English-language
publica ions we e included in he sea ch. The i les, abs ac s, and ull ex s o he a icles we e hen ead in o de o
il e hem.
We included p ospec i e o e ospec i e coho s udies, obse a ional s udies, o case se ies; s udies ha in es iga e
diagnos ic me hods o blun ca diac inju y (BCI). S udies ha assess imaging modali ies (CT, DECT, CMR,
echoca diog aphy) o bioma ke -based diagnos ics (ECG, oponins). We include s udies epo ing on diagnos ic
accu acy, sensi i i y, and speci ici y o he abo e modali ies. S udies e alua ing clinical ou comes associa ed wi h he
use o hese diagnos ic ools (e.g., Majo Ad e se Ca diac E en s [MACE], mo ali y, o need o in e en ion).
The dispu e among he e iewe s o e eligibili y was esol ed h ough discussion. A e he disco e ed eco ds we e
i s so ed by i le and abs ac , po en ially ele an a icles we e examined in hei en i e y. The e e ences in he
lis ed pape s we e sc eened o eligibili y. I he ull- ex e sion o he wo k was no a ailable, an email was sen o he
ela ed au ho s; i hey did no espond, a ollow-up email was sen .
We ex ac da a on a p edesigned Google shee , we ex ac ed da a on s udy cha ac e is ics (au ho , s udy design, and
s udy a ea); popula ion and pa icipan s cha ac e is ics; diagnos ic me hods; and key indings.
Quali y assessmen o he included s udies was pe o med acco ding o ROBINS-I ool. Bu ell e al. (2017) s udy
(Bu ell e al. 2017) showed a mode a e isk o bias, due o con ounding and missing da a om a small sample size.
Hamme e al. (2015) (Hamme e al. 2016) showed a high isk o bias, in con ounding and measu emen due o he
e ospec i e na u e and CT's poo sensi i i y in de ec ing ca diac con usions. Sade e al. (2017) had a low o mode a e
isk o bias. Vasileiou e al. (2019) had a high isk o bias, in con ounding and measu emen because CXR alone is no a
dependable diagnos ic ool. Aude e e al. (2014) had a mode a e isk o bias, wi h conce ns o e missing da a and
a iabili y in ECG and oponin measu emen .
Table 1 Quali y assessmen o he included s udies wi h he ROBINS-I ool
S udy (Au ho , Yea )
Bu ell e al.,
2017
Hamme e al.,
2015
Sade e al.,
2017
Vasileiou e al.,
2019
Aude e e al.,
2014
Bias due o Con ounding
Mode a e
High
Mode a e
High
Mode a e
Bias in Selec ion o Pa icipan s
Low
Mode a e
Low
Mode a e
Low
Bias in Classi ica ion o
In e en ions
Low
Low
Low
Low
Low
Bias due o De ia ions om
In ended In e en ions
Low
Low
Low
Low
Low
Bias due o Missing Da a
Mode a e
Mode a e
Low
Mode a e
Mode a e
Bias in Measu emen o
Ou comes
Low
High
Low
High
Mode a e
Bias in Selec ion o Repo ed
Resul s
Low
Mode a e
Low
Mode a e
Mode a e
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O e all Risk o Bias
Mode a e
High
Low o
Mode a e
High
Mode a e
3. Resul
In his sys ema ic e iew s udy, we include 5 a icles published in he pe iod om 2014 o 2024. The s udies aimed o
assess he ole o diagnos ic me hods in de ec ing ca diac con usions and associa ed inju ies in pa ien s wi h blun
ca diac auma.
Figu e 1 PRISMA conso cha o s udies selec ion
Bu ell e al. (2017) s udy examined he use o ca diac magne ic esonance imaging (CMR) in diagnosing blun ca diac
inju y (BCI). This p ospec i e coho s udy includes 42 majo auma pa ien s, 21 wi h o ches inju y and ele a ed
oponin le els, and 21 con ols. The s udy ound ha 28% o pa ien s wi h ches inju ies exhibi ed abno mal CMR
indings, such as myoca dial edema, egional wall mo ion abno mali ies, and myoca dial hemo hage. Le en icle was
he mos commonly a ec ed a ea. Majo ad e se ca diac e en s (MACE), including en icula a hy hmia and
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2251-2257
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hypo ension equi ing ino opes, occu ed in i e pa ien s. The s udy ound ha CMR has a 60% sensi i i y and 81%
speci ici y MACE p edic ion, i ’s ound o be be e in he diagnosis o suspec ed BCI in compa ison o con en ional
me hods like elec oca diog aphy (ECG) and oponin.
Hamme e al. (2015) e ospec i e s udy assessed he use o compu ed omog aphy (CT) in ca diac con usions
diagnosis in blun auma pa ien s. His s udy includes 42 pa ien s wi h clinically diagnosed BCI. CT iden i ied
abno mali ies o he hea o pe ica dium in 82% o pa ien s wi h con i med BCI. Howe e , he de ec ion o myoca dial
con usions was poo , CT sensi i i y was 0% o igh en icula con usions and 22% o le en icula con usions.
The s udy emphasized ha CT disgnosis o se e e ho acic auma indi ec ly indica e BCI, and myoca dial
hypoenhancemen on CT alone is no a dependable diagnos ic ool. The au ho s ad ised using CT as a complemen a y
ool wi h echoca diog aphy o CMR o diagnosing BCI.
Sade e al. (2017) s udy examined he easibili y o dual-ene gy compu ed omog aphy (DECT) in diagnosing ca diac
con usions in blun ca diac inju ies. They included 17 pa ien s who unde wen DECT wi hin 48 hou s o auma, wi h a
ollow-up scan conduc ed one yea la e . Con usions we e p ima ily loca ed in he le en icula ee wall, en icula
sep um, and apex. In 10 pa ien s, con usion a eas esol ed comple ely on ollow-up, while in ou pa ien s, con usions
pe sis ed and showed signi ican imp o emen . Findings indica e high in e obse e ag eemen in de ec ing
con usions, sugges ing DECT as a po en ially e ec i e ool o diagnosing blun ca diac inju ies.
Vasileiou e al. (2019) e ospec i e coho s udy examined he clinical signi icance o a widened medias inum (WM)
on ches X- ay (CXR) ollowing blun auma. Among 749 pa ien s analyzed, 67% had a WM. Despi e he ini ial suspicion
ha WM indica e ao ic inju y (AI), 26% had posi i e indings on CT, wi h jus wo con i med cases o AI. The s udy
epo ed a 100% sensi i i y and 33% speci ici y o CXR in de ec ing AI, highligh ing i s limi ed diagnos ic accu acy.
Aude e e al. (2014) e ospec i e desc ip i e s udy examined he use o ECG and oponin in diagnosing myoca dial
con usion in auma pa ien s wi h s e nal ac u es. Among 54 pa ien s, 72% unde wen ini ial ECGs, and 33% ecei ed
ollow-up ECGs. Addi ionally, 30% had oponin es ing, and 2% showed ele a ed le els. A combina ion o ECG and
oponin es ing yielded a 100% sensi i i y and 45-89% speci ici y.
Table 2 cha ac e is ics o include s udies
S udy
(Au ho ,
Yea )
S udy Design
S udy Aim
Pa icipan s
Cha ac e is ics
Ou come
Me hodology
Bu ell e
al., 2017
P ospec i e
coho s udy
To e alua e he
incidence and se e i y
o blun ca diac inju y
(BCI) using ca diac
magne ic esonance
(CMR) and compa e i
o s anda d diagnos ic
me hods
42 majo auma
pa ien s (21 wi h
ches auma and 21
con ols), July 2013 -
Jan 2015
6/21 (28%)
pa ien s wi h ches
inju ies had
abno mal CMR
scans; MACE
occu ed in 5
pa ien s
CMR wi hin 7 days,
ECG, T oponin, and
echoca diog aphy
Hamme e
al., 2015
Re ospec i e
s udy
To e alua e CT
indings in blun
ca diac inju y
42 pa ien s wi h
blun ca diac inju y
(Median age: 52,
86% male)
CT was poo ly
sensi i e o igh
en icula
con usions (0%)
and le en icula
con usions (22%)
Ches CT, ECG,
T oponin, and
echoca diog aphy
Sade e al.,
2017
P ospec i e
s udy
To assess he
easibili y o dual-
ene gy compu ed
omog aphy (DECT)
o diagnosing ca diac
con usion
17 pa ien s (10 men,
7 women, median
age 51)
DECT iden i ied
con usions
p ima ily in he le
en icle; ollow-up
showed eco e y in
mos pa ien s
DECT imaging wi hin
48 hou s o auma,
ollow-up DECT a
~1 yea
Vasileiou e
al., 2019
Re ospec i e
coho s udy
To de e mine he
signi icance o
widened
749 blun auma
pa ien s (67% MVC,
76% male)
Only 26% had
posi i e CT
indings; sensi i i y
CXR, Ches CT
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2255
medias inum on ches
X- ay (CXR) in blun
auma
o WM o ao ic
inju y was 100%,
speci ici y was 33%
Aude e e
al., 2014
Re ospec i e
desc ip i e
s udy
To e alua e he use o
ECG and oponin in
assessing myoca dial
con usion in s e nal
ac u e cases
54 auma pa ien s
wi h suspec ed
s e nal ac u e (51
yea s mean age,
54% emale)
72% had ini ial
ECGs, 33% had
ollow-up ECGs,
30% had oponin
dosage; ECG +
oponin
combina ion had
100% sensi i i y
ECG, ollow-up ECG,
T oponin, Ches X-
ay, Ca diac
ul asound
Table 3 Main indings o he included s udies
S udy
(Au ho ,
Yea )
Demog aphics
S udy
Du a ion
Type o
T auma
Me hods Used
o Diagnosis
Accu acy o Me hod
(Sensi i i y/Speci ici y)
Bu ell e
al., 2017
42 majo auma
pa ien s
July 2013 -
Jan 2015
Blun ca diac
inju y
Ca diac Magne ic
Resonance
Imaging (CMR)
Sensi i i y: 60%, Speci ici y:
81%
Hamme
e al.,
2015
42 pa ien s wi h
blun ca diac
inju y
2006 -
2013
Blun ca diac
inju y
Compu ed
Tomog aphy (CT),
ECG, T oponin,
Echoca diog aphy
Myoca dial hypoenhancemen
on CT: Sensi i i y: 0% (RV),
22% (LV)
Sade e al.,
2017
17 pa ien s (10
men, 7 women,
median age 51)
Feb 2014 -
Sep 2015
Mildes blun
ca diac inju y
Dual-Ene gy CT
(DECT)
High in e obse e ag eemen
(κ = 1.0) bu no clea
sensi i i y/speci ici y
epo ed
Vasileiou
e al.,
2019
749 pa ien s wi h
widened
medias inum
Jan 2017 -
June 2017
Blun auma
Ches X- ay (CXR),
Ches CT
Sensi i i y: 100%, Speci ici y:
33%
Aude e e
al., 2014
54 pa ien s wi h
suspec ed s e nal
ac u es
Jan 2007 -
Oc 2010
S e nal
ac u e
auma
ECG, T oponin
ECG + T oponin: Sensi i i y:
100%, Speci ici y: 45-89%
4. Discussion
BCI diagnosis emain di icul due o i s a iable clinical p esen a ions and he lack o accep ed gold s anda d o
diagnosis. The included i e s udies (Aude e e al. 2014; Bu ell e al. 2017; Hamme e al. 2016; Sade e al. 2017;
Vasileiou e al. 2019) ocused on imaging modali ies, including CMR, CT, and DECT o assess BCI.
The use o imaging modali ies in BCI diagnosis s ill a opic o deba e. CXR always used ini ial sc eening ool, bu s udies
ound ha a widened medias inum on CXR has low speci ici y (33%) o de ec ing ao ic inju y (Vasileiou e al. 2019),
making i an un eliable diagnos ic ool on i s own (Gi ón-A ango and D’Empai e 2022). CT has been mo e widely used
due o i s abili y o de ec associa ed ho acic inju ies. Hamme e al. (2015) ound ha CT has poo sensi i i y in
myoca dial con usions de ec ion, pa icula ly in he igh en icle (Gi ón-A ango and D’Empai e 2022). Sade e al.
(2017) examined DECT as an al e na i e, inding ha i shows a high in e obse e ag eemen in de ec ing myoca dial
con usions, wi h imp o ed accu acy.
CMR was highly sensi i e imaging modali y o de ec ing myoca dial edema and ib osis. Bu ell e al. (2017) ound ha
CMR de ec ed myoca dial abno mali ies in 28% o pa ien s wi h suspec ed BCT and show a s ong co ela ion wi h
clinical ou comes (Gi ón-A ango and D’Empai e 2022). Despi e i s diagnos ic accu acy, CMR is no p ac ical in he acu e
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auma se ing due o pa ien ins abili y and limi ed a ailabili y. Shoa e al. (2021) sugges ed ha al hough CMR and
DECT a e aluable, hei applica ion in eme gency se ings emains limi ed.
Lieshou e al. (2021) e alua ed ans ho acic echoca diog aphy (TTE). TTE show a poo sensi i i y (45%) o
myoca dial con usion, and 88% speci ici y (Van Lieshou e al. 2021). TEE show ad an ages in pe iope a i e auma
pa ien s, as i p o ides be e imaging quali y in hemodynamically uns able pa ien s (Gi ón-A ango and D’Empai e
2022). A sys ema ic e iew and me a-analysis, ound ha TEE had a sensi i i y o 86.7% and speci ici y o 72.1%, which
suppo i s use in suspec ed BCI cases (Ky iazidis e al. 2023).
ECG and ca diac bioma ke s we e used widely as cos -e ec i e sc eening ools. Aude e e al. (2014) es ed he ole o
ECG and oponin in myoca dial con usion assessmen and ound ha ECG abno mali ies we e de ec ed in many
pa ien s wi h suspec ed BCI, bu i s speci ici y a ied (Gi ón-A ango and D’Empai e 2022). The combina ion o ECG and
oponin I (cTnI) had a 100% nega i e p edic i e alue o clinically signi ican BCI, making i a highly e ec i e ule-ou
s a egy (Salim e al. 2001). ECG and ca diac bioma ke s show high speci ici y (>80%), and low sensi i i y, so hey
should no be used in isola ion o diagnosis (Ky iazidis e al. 2023).
The indings o he included s udies highligh he need o a mul imodal app oach o diagnose BCI. Lied ke and DeMu h
s udy p o ided a his o ical pe spec i e, show ha BCI some imes goes undiagnosed due o he o e shadowing e ec s
o o he auma ic inju ies (Lied ke and DeMu h 1973). This emains ele an oday, as many pa ien s wi h signi ican
ho acic auma no exhibi immedia e ca diac symp oms, necessi a ing ca e ul moni o ing. Shoa e al. (2021) de ec ed
he a iabili y in clinical p esen a ion and he impo ance o combining mul iple diagnos ic modali ies o imp o e
diagnosis.
Ea ly iden i ica ion o high- isk pa ien s is impo an o s a managemen . Pa ien s wi h no mal ECG and oponin can
some imes sa ely discha ged (Salim e al. 2001). Pa ien s wi h pe sis en ECG abno mali ies, ele a ed bioma ke s, o
imaging-con i med s uc u al inju ies equi e close moni o ing and possible in e en ion. Hemodynamically uns able
pa ien s, pa icula ly hose wi h amponade o al ula up u e, should be assessed o he need o u gen su gical
managemen (Gi ón-A ango and D’Empai e 2022).
Lis o abb e ia ions
• BCI, Blun Ca diac Inju y
• CMR, Ca diac Magne ic Resonance Imaging
• CT, Compu ed Tomog aphy
• DECT, Dual-Ene gy Compu ed Tomog aphy
• TEE, T ansesophageal Echoca diog aphy
• ECG, Elec oca diog aphy
• cTnI, Ca diac T oponin I
• CXR, Ches X- ay
• WM, Widened Medias inum
• AI, Ao ic Inju y
• MACE, Majo Ad e se Ca diac E en s
• MVC, Mo o Vehicle Collision
• PRISMA, P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses
• ROBINS-I, Risk o Bias in Non-Randomized S udies - o In e en ions
• PPV, Posi i e P edic i e Value
• NPV, Nega i e P edic i e Value
5. Conclusion
Mul i ace ed na u e o BCI diagnosis and managemen , sugges ed he need o a comp ehensi e diagnos ic app oach.
CMR and DECT o e high diagnos ic p ecision, hey a e some imes imp ac ical in acu e auma se ings. TEE has
eme ged as a highly e ec i e bedside ool, especially in uns able pa ien s. ECG and oponins we e sc eening ools, hey
show high speci ici y and mode a e sensi i i y, and can be used o ule ou BCI. Fu u e esea ch should es ablish
s anda dized diagnos ic guidelines which in eg a e hese me hods o imp o e BCI ea ly de ec ion and managemen .
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2251-2257
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Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
Re e ences
[1] andNA. Blun Ca diac Inju y. J T auma. 1992 No ;33(5):649–50. doi: 10.1097/00005373-199211000-00001.
[2] Aude e JS, Emond M, Sco H, Lo ie G. In es iga ion o Myoca dial Con usion wi h S e nal F ac u e in he
Eme gency Depa men : Mul icen e Re iew. Can Fam Physician. 2014 Feb;60(2):e126–30. PMID: 24522690.
[3] Bu ell AJC, Kaye DM, Fi zge ald MC, Coope DJ, Ha e JL, Cos ello BT, Taylo AJ. Ca diac Magne ic Resonance
Imaging in Suspec ed Blun Ca diac Inju y: A P ospec i e, Pilo , Coho S udy. Inju y. 2017 May;48(5):1013–19.
doi: 10.1016/j.inju y.2017.02.025.
[4] El-Chami MF, Nicholson W, Helmy T. Blun Ca diac T auma. J Eme g Med. 2008 Aug;35(2):127–33. doi:
10.1016/j.jeme med.2007.03.018.
[5] F azee RC, Mucha P, Fa nell MB, Mille FA. Objec i e E alua ion o Blun Ca diac T auma. J T auma. 1986
Jun;26(6):510–20. doi: 10.1097/00005373-198606000-00004.
[6] Gi ón-A ango L, Pé ez D’Empai e P. Is The e a Role o T ansesophageal Echoca diog aphy in he Pe iope a i e
T auma Pa ien ? Cu Anes hesiol Rep. 2022 Jun;12(2):210–16. doi: 10.1007/s40140-022-00526-0.
[7] Hamme MM, Rap is DA, Cummings KW, Mellnick VM, Bhalla S, Schue e DJ, Rap is CA. Imaging in Blun Ca diac
Inju y: Compu ed Tomog aphic Findings in Ca diac Con usion and Associa ed Inju ies. Inju y. 2016
May;47(5):1025–30. doi: 10.1016/j.inju y.2015.11.008.
[8] Ky iazidis IP, Jakob DA, He nández Va gas JA, F anco OH, Degiannis E, Do n P, Pouwels S, Pa el B, Johnson I,
Houdlen CJ, Whi eley GS, Head M, Lala A, Mum az H, Sole JA, Mello K, Rawa D, Ahmed AR, Ahmad SJS,
Exadak ylos A. Accu acy o Diagnos ic Tes s in Ca diac Inju y a e Blun Ches T auma: A Sys ema ic Re iew and
Me a-Analysis. Wo ld J Eme g Su g. 2023 Ap ;18(1):36. doi: 10.1186/s13017-023-00504-9.
[9] Lied ke AJ, DeMu h WE. Nonpene a ing Ca diac Inju ies: A Collec i e Re iew. Am Hea J. 1973 No ;86(5):687–
97. doi: 10.1016/0002-8703(73)90349-9.
[10] Van Lieshou EMM, Ve ho s ad MHJ, Van Sil hou DJT, Dubois EA. Diagnos ic App oach o Myoca dial Con usion:
A Re ospec i e E alua ion o Pa ien Da a and Re iew o he Li e a u e. Eu J T auma Eme g Su g. 2021
Aug;47(4):1259–72. doi: 10.1007/s00068-020-01305-4.
[11] Sade R, Kan a ci M, Ogul H, Bay ak u an U, Uzkese M, Aslan S, Aksakal E, Beci N. The Feasibili y o Dual-Ene gy
Compu ed Tomog aphy in Ca diac Con usion Imaging o Mildes Blun Ca diac Inju y. J Compu Assis Tomog .
2017 May;41(3):354–59. doi: 10.1097/RCT.0000000000000545.
[12] Salim A, Velmahos GC, Jindal A, Chan L, Vassiliu P, Belzbe g H, Asensio J, Deme iades D. Clinically Signi ican
Blun Ca diac T auma: Role o Se um T oponin Le els Combined wi h Elec oca diog aphic Findings. J T auma.
2001 Feb;50(2):237–43. doi: 10.1097/00005373-200102000-00008.
[13] Shoa S, Hosseini FS, Nade an M, Kha andi S, Tabibzadeh E, Kha andi S, Shoa N. Ca diac Inju y Following Blun
Ches T auma: Diagnosis, Managemen , and Unce ain y. In J Bu ns T auma. 2021 Ap ;11(2):80–89.
[14] Vasileiou G, Qian S, Al-Ghamdi H, Pace D, Ra an R, Mulde M, Namias N, Yeh DD. Blun T auma: Wha Is Behind
he Widened Medias inum on Ches X-Ray (CXR)? J Su g Res. 2019 Sep;243:23–26. doi:
10.1016/j.jss.2019.04.079.
[15] an Wijngaa den MH, Ka my-Jones R, Talwa MK, Simone i V. Blun Ca diac Inju y: A 10-Yea Ins i u ional
Re iew. Inju y. 1997 Jan;28(1):51–55. doi: 10.1016/S0020-1383(96)00118-0.
