To review how doctors on duty in emergency departments in South Africa diagnose acute cardiac injury following blunt chest trauma

Afeltra, Giovanni Francesco Maurizio
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INTRODUCTION Cardiac injury following blunt chest trauma (BCT) presents a clinical spectrum of varying severity ranging from asymptomatic to severe and life-threatening. Attempts to diagnose acute cardiac injury may lead to unnecessary investigations and hospitalisation. Conversely, those patients “not at risk” could potentially be discharged from hospital. This research reviewed what methods are utilised by doctors to identify those patients at risk of acute cardiac injury. METHODS An on-line questionnaire was mailed to doctors working in emergency departments (EDs) throughout South Africa to ascertain what history, examination, and special investigations should be performed on patients presenting with blunt chest injury to exclude cardiac injury. RESULTS These revealed varied responses with inappropriate investigations and lacked unanimity in the diagnostic methods. The majority of doctors did not adhere to up-to-date consensus driven and evidenced based up-to-date practice There was not much difference in the respondents responses between specialist emergency physicians (SEPs) and general practitioners (GPs). CONCLUSION A high index of suspicion based on careful history taking and physical examination together with specific diagnostic testing limited to identifying those patients at risk of a cardiac injury (and developing cardiac complications) presenting with BCT should be the cornerstone of this diagnostic challenge. It was evident that the diagnosis of acute cardiac injury remains an elusive challenge and lacks consistent utilisation of diagnostic criteria.
Thesis (M.Sc. (Med.) (Emergency Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2014.