Early detection of myocardial contusion and its complications in patients with blunt trauma.
 Myocardial contusion remains an elusive clinical entity, which consumes a disproportionate amount of scarce and expensive critical care resources for the purpose of cardiac monitoring.
 This study attempts to define a group of patients at high risk who can be identified from the available data present at the time of admission.
 All patients admitted with the suspicion of a myocardial contusion over a 3-year period were retrospectively studied.
 The records were examined for history, physical findings, electrocardiographic (ECG) results, creatine kinase levels, Injury Severity Score (ISS), and echocardiographic findings.
 A diagnosis of a myocardial contusion was made if patients had an ECG consistent with acute injury, increased creatine kinase-MB, or an abnormal echocardiogram consistent with acute injury.
 Patients were stratified into two groups: Group 1 patients satisfied the criteria for a myocardial contusion and Group 2 patients lacked sufficient evidence to substantiate this diagnosis.
 The records were then examined for the presence of factors available in the emergency room that might be predictive of a myocardial contusion or its complications.
 A total of 88 patients were evaluated; 27 of these were found to have a myocardial contusion (Group 1) with 61 patients placed in Group 2 (no myocardial contusion).
 Group 1 patients had an abnormal admission ECG (p less than 0.05), and an ISS greater than or equal to 10 (p less than 0.05).
 Multivariate analysis identified two factors predictive of a myocardial contusion: an abnormal ECG and an ISS greater than 10.
 When these two predictors were absent, the probability of a myocardial contusion was 1%.
 No predictors of a complication of a myocardial contusion were identified.
 These data suggest that a combination of easily obtained variables in the emergency department can be used to select a patient population at high risk for myocardial contusion.
 Prospective evaluation of these variables is necessary.
