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Three Part Question

Is [BNP] level a good indicator of underlying [cardiac damage] after [blunt chest trauma]?

Clinical Scenario

A 45 year old man attends the emergency department after being involved in a road traffic accident. He has sustained a blunt chest injury during the impact and has bruising across his chest wall. His ECG shows non specific ST segment changes and the chest radiograph are normal. You wonder about the benefit of performing a BNP level to aid the diagnosis or exclusion of myocardial contusion.

Search Strategy

Medline 1966-09/2016 using the Pubmed interface
((N-terminal pro-B-type natriuretic peptide OR NT-proBNP OR BNP OR B-type natriuretic peptide) AND (Wounds, nonpenetrating OR Thoracic Injuries OR blunt chest injuries OR blunt chest trauma OR blunt thoracic injury OR blunt thoracic trauma)) AND (Heart Injur* OR myocardial contusion OR cardiac contusion OR myocardial damage OR myocardial injur* OR cardiac damage OR cardiac injur*) LIMIT to human AND English language

Search Outcome

Altogether 18 papers were found of which 1 was directly relevant to the three part question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
De'Ath HD, Rourke C, Davenport R, Manson J, Renfrew I, Uppal R, Davies LC, Brohi K. Epub 2012 Mar 21. UK	Injured adult patients eligible for enrolment in the Activation of Coagulation and Inflammation in Trauma 2 study, and admitted to the intensive care unit between January 2008 and January 2010.	Retrospective observational study	Mortality	BNP levels were higher in non-survivors on admission (median 550 versus 403 fmol/ml; P = 0·022), after 24 h (794 versus 567 fmol/ml; P = 0·033) and after 72 h (1043 versus 753 fmol/ml; P = 0·036), as were admission troponin I levels.	Small number of enrolled patients.

Comment(s)

There is only a single study available to answer this question.

Clinical Bottom Line

Elevation of BNP appears to be a sensitive marker of secondary myocardial injury.

References

1. De'Ath HD, Rourke C, Davenport R, Manson J, Renfrew I, Uppal R, Davies LC, Brohi K. Clinical and biomarker profile of trauma-induced secondary cardiac injury. Br J Surg. 2012 Jun;99(6):789-97