Troponin T in stable patients with penetrating chest trauma: A diagnostic study

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Abstract
Background: Penetrating chest trauma is a leading cause of mortality in South Africa. In haemodynamically stable patients with injuries within the cardiac box, occult cardiac injury remains difficult to detect, particularly in resource-limited settings. The diagnostic utility of troponin T in this population is poorly defined. Methods: A retrospective cohort study was conducted on haemodynamically stable patients presenting with penetrating anterior chest injuries to Charlotte Maxeke Johannesburg Academic Hospital between May 2022 and June 2024. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of serum troponin T were calculated against subxiphoid pericardial window, surgical findings, ultrasound and electrocardiography. Results: Among 256 patients (96% male; median age 31 years), 65% sustained stab wounds and 35% gunshot wounds. Serum Troponin T demonstrated high sensitivity (90.5% pooled against definitive modalities) and an NPV of up to 88.8% in concordance analysis with commonly used screening modalities (non-reference comparators); NPV against definitive reference standards ranged from 50.0% to 66.7%, but had low specificity (37.5% pooled). Overall mortality was 3.9% and was significantly associated with haemopericardium (p = 0.020) and pleural injury (p = 0.029). Conclusion: Serum Troponin T offered high sensitivity and NPV for excluding occult cardiac injury in haemodynamically stable patients, supporting its role as an accessible screening adjunct in resource-constrained emergency departments. Contribution: This study represents the largest cohort evaluating serum troponin T in haemodynamically stable penetrating chest trauma, addressing a critical evidence gap. The findings are directly relevant to South African clinical practice and align with the journal’s focus on improving patient care in resource-limited settings.

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