Analytic Reviews : Routine Intensive Care Unit Admission Is Not Indicated for Suspected Myocardial Contusion

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Abstract
The clinical records of 72 patients with blunt chest trauma who were admitted to our intensive care unit (ICU) exclusively to rule out myocardial contu sion were retrospectively reviewed. Electrocardiogram (ECG) abnormalities were present on admission in 56% of patients, and all patients had negative creatine phos phokinase isoenzyme levels. Eight percent of patients required treatment for arrhythmias, all of whom were symptomatic at the time of initial presentation. Delayed cardiac complications developed in none. Patients with normal ECGs on admission had a benign hospital course. This study suggests that patients with blunt chest trauma who are admitted to the ICU solely to rule out myocardial contusion in the absence of initial ECG ab normalities or hemodynamic instability are unlikely to experience delayed cardiac complications. A policy of routine ICU admission is neither medically indicated nor cost effective. Observation in a monitored medical/ surgical ward may provide an acceptable alternative for this group of patients.

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