# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Kindesunterhalt: Rechtliche Grundlagen und praktische Herausforderungen – heute und demnächst

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.relation.ispartof[].value
FamPra.ch - die Praxis des Familienrechts

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
300 - Social sciences, sociology & anthropology::340 - Law

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Kindesunterhalt: Rechtliche Grundlagen und praktische Herausforderungen – heute und demnächst

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
A Note on the Use of Sum in the Logic of Proofs

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
The Logic of Proofs~LP, introduced by Artemov, encodes the same reasoning as the modal logic~S4 using proofs explicitly present in the language. In particular, Artemov showed that three operations on proofs (application~$\cdot$, positive introspection~!, and sum~+) are sufficient to mimic provability concealed in S4~modality. While the first two operations go back to G{\"o}del, the exact role of~+ remained somewhat unclear. In particular, it was not known whether the other two operations are sufficient by themselves. We provide a positive answer to this question under a very weak restriction on the axiomatization of LP.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.sponsorship[].value
Institut für Informatik und angewandte Mathematik (IAM)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.relation.conference[].value
Proceedings of the 7th Panhellenic Logic Symposium

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
A Note on the Use of Sum in the Logic of Proofs

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.oairecerif.author.affiliation[].value
Institut für Informatik und angewandte Mathematik (IAM)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Inhaled corticosteroids in subacute and chronic cough

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.relation.ispartof[].value
Praxis - schweizerische Rundschau für Medizin

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
600 - Technology::610 - Medicine & health

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Inhaled corticosteroids in subacute and chronic cough

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Inhalative Kortikosteroide bei subakutem und chronischem Husten

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Search for type-III seesaw heavy leptons in dilepton final states in pp collisions at √s = 13 TeV with the ATLAS detector

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.note[].value
The Atlas collaboration. Es sind nur die Berner Autor*innen erwähnt.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.sponsorship[].value
Albert Einstein Center for Fundamental Physics (AEC)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.relation.ispartof[].value
The European physical journal. C, Particles and fields

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Search for type-III seesaw heavy leptons in dilepton final states in pp collisions at √s = 13 TeV with the ATLAS detector

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.oairecerif.author.affiliation[].value
Albert Einstein Center for Fundamental Physics (AEC)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.oairecerif.author.affiliation[].value
Albert Einstein Center for Fundamental Physics (AEC)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
The sedimentary and remote-sensing reflection of biomass burning in Europe

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
Aim
We provide the first European-scale geospatial training set relating the charcoal signal in surface lake sediments to fire parameters (number, intensity and area) recorded by satellite moderate resolution imaging spectroradiometer (MODIS) sensors. Our calibration is intended for quantitative reconstructions of key fire-regime parameters by using sediment sequences of microscopic (MIC from pollen slides, particles 10–500 µm) and macroscopic charcoal (MAC from sieves, particles > 100 µm).

Location
North–south and east–west transects across Europe, covering the mediterranean, temperate, alpine, boreal and steppe biomes.

Time period
Lake sediments and MODIS active fire and burned area products were collected for the years 2012–2015.

Methods
Cylinder sediment traps were installed in lakes to annually collect charcoal particles in sediments. We quantitatively assessed the relationships between MIC and MAC influx (particles/cm2/year) and the MODIS-derived products to identify source areas of charcoal and the extent to which lake-sediment charcoal is linked to fire parameters across the continent.

Results
Source area of sedimentary charcoal was estimated to a 40-km radius around sites for both MIC and MAC particles. Fires occurred in grasslands and in forests, with grass morphotypes of MAC accurately reflecting the burned fuel-type. Despite the lack of local fires around the sites, MAC influx levels reached those reported for local fires. Both MIC and MAC showed strong and highly significant relationships with the MODIS-derived fire parameters, as well as with climatic variation along a latitudinal temperature gradient.

Main conclusions
MIC and MAC are suited to quantitatively reconstructing fire number and fire intensity on a regional scale. However, burned area may only be estimated using MAC. Local fires may be identified by using several lines of evidence, e.g. analysis of large particles (> 600 µm), magnetic susceptibility and sedimentological data. Our results offer new insights and applications to quantitatively reconstruct fires and to interpret available sedimentary charcoal records.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.sponsorship[].value
Geographisches Institut der Universität Bern (GIUB)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
The sedimentary and remote-sensing reflection of biomass burning in Europe

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.oairecerif.author.affiliation[].value
Geographisches Institut der Universität Bern (GIUB)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Ambulatory management of heavy menstrual bleeding.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
Heavy menstrual bleeding (HMB) has significant adverse effects on the quality of life of many women, placing an economic burden on both health services and society at large. Thus, it is essential that all women with HMB have easy access to the proper diagnostic and therapeutic work-up in an outpatient fashion, avoiding the more time-consuming inpatient management. This new outpatient approach for HMB is one of the latest development of gynecological practice and can offer both diagnostic and therapeutic procedures. This manuscript aims to show the current possibilities of the modern management of HMB, which can be safely and effectively accomplished in the outpatient setting: global and directed endometrial biopsy, levonorgestrel intrauterine system insertion as well as minimally invasive surgical procedures (encompassing a variety of operative hysteroscopic procedures and second-generation endometrial ablation) are described below.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
600 - Technology::610 - Medicine & health

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Ambulatory management of heavy menstrual bleeding.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Ordnungsgeldbeschluss als Zivil- und Handelssache, zu EuGH-Urteil vom 18.10.2011 C-406/09, "Realchemie Nederland"

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.sponsorship[].value
Institut für Internationales Privatrecht und Verfahrensrecht

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
300 - Social sciences, sociology & anthropology::340 - Law

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Ordnungsgeldbeschluss als Zivil- und Handelssache, zu EuGH-Urteil vom 18.10.2011 C-406/09, "Realchemie Nederland"

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.oairecerif.author.affiliation[].value
Institut für Internationales Privatrecht und Verfahrensrecht

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Neural networks engaged in tactile object manipulation: patterns of expression among healthy individuals

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
Somatosensory object discrimination has been shown to involve widespread cortical and subcortical structures in both cerebral hemispheres. In this study we aimed to identify the networks involved in tactile object manipulation by principal component analysis (PCA) of individual subjects. We expected to find more than one network.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
600 - Technology::610 - Medicine & health

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Neural networks engaged in tactile object manipulation: patterns of expression among healthy individuals

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
600 - Technology::610 - Medicine & health

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Selbstverletzung und Borderline-Störungen im Kindes- und Jugendalter

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.sponsorship[].value
Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie (KJP)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
600 - Technology::610 - Medicine & health

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Selbstverletzung und Borderline-Störungen im Kindes- und Jugendalter

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.oairecerif.author.affiliation[].value
Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie (KJP)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Root volatiles in plant-plant interactions I: High root sesquiterpene release is associated with increased germination and growth of plant neighbors

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
Volatile organic compounds (VOCs) emitted by plant leaves can influence the physiology of neighboring plants. In contrast to leaf VOCs, little is known about the role of root VOCs in plant‐plant interactions. Here, we characterize constitutive root VOC emissions of the spotted knapweed (Centaurea stoebe) and explore the impact of these VOCs on the germination and growth of different sympatric plant species. We show that C. stoebe roots emit high amounts of sesquiterpenes, with estimated release rates of (E)‐β‐caryophyllene above 3 μg g‐1 dw h‐1. Sesquiterpene emissions show little variation between different C. stoebe populations, but vary substantially between different Centaurea species. Through root transcriptome sequencing, we identify six root‐expressed sesquiterpene synthases (TPSs). Two root‐specific TPSs, CsTPS4 and CsTPS5, are sufficient to produce the full blend of emitted root sesquiterpenes. VOC‐exposure experiments demonstrate that C. stoebe root VOCs have neutral to positive effects on the germination and growth of different sympatric neighbors. Thus, constitutive root sesquiterpenes produced by two C. stoebe TPSs are associated with facilitation of sympatric neighboring plants. The release of root VOCs may thus influence plant community structure in nature.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Root volatiles in plant-plant interactions I: High root sesquiterpene release is associated with increased germination and growth of plant neighbors

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Iron Fertilization of the Subantarctic Ocean During the Last Ice Age

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
John H. Martin, who discovered widespread iron limitation of ocean productivity, proposed that dust-borne iron fertilization of Southern Ocean phytoplankton caused the ice age reduction in atmospheric carbon dioxide (CO2). In a sediment core from the Subantarctic Atlantic, we measured foraminifera-bound nitrogen isotopes to reconstruct ice age nitrate consumption, burial fluxes of iron, and proxies for productivity. Peak glacial times and millennial cold events are characterized by increases in dust flux, productivity, and the degree of nitrate consumption; this combination is uniquely consistent with Subantarctic iron fertilization. The associated strengthening of the Southern Ocean’s biological pump can explain the lowering of CO2 at the transition from mid-climate states to full ice age conditions as well as the millennial-scale CO2 oscillations.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.publisher[].value
American Association for the Advancement of Science

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
500 - Science::550 - Earth sciences & geology

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Iron Fertilization of the Subantarctic Ocean During the Last Ice Age

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.oairecerif.author.affiliation2[].value
Oeschger Centre for Climate Change Research (OCCR)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.relation.ispartofbook[].value
Direkte Demokratie. Analysen im internationalen Vergleich

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
300 - Social sciences, sociology & anthropology::320 - Political science

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Pottery beyond Cultures - A praxeological Approach to Mobility, Entanglements and
Transformations in Prehistoric Societies

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
Life in the 21st century seems to be particularly shaped by mobility, from daily commuter movements to poverty-, war- or climate-induced migration. But what role has spatial mobility played in the prehistoric past?
Surprisingly, we still do know rather little about it. This is particularly true for the European Neolithic societies. Questionable premises like concepts of social and cultural coherence of residence groups and the ethnic interpretation of archaeological cultures fostered ideas of static and homogeneous social entities with fixed borders. Beyond that farming – understood as the core of the Neolithic way of life - was rather associated with sedentariness than with mobility.
Yet the numerous outstandingly preserved Neolithic UNESCO World Heritage wetland sites of the Northern Alpine Foreland dating to 4th millennium BC are a solid research basis to address such questions. In particular, many of the dendrochronologically dated settlements on Lake Zurich and Lake Constance of the period between 3950 and 3800 BCE offer a rare opportunity to investigate cultural, social and economic processes with a high temporal and spatial resolution. In this paper we will use them as a case study to inquire the role of spatial mobility, for cultural entanglements and transformations in prehistoric societies.
Taking three recent paradigmatic shifts as a theoretical starting point – the mobility, practice and material turn –, we have developed a mixed-methodology to investigate spatial mobility using ceramics. While qualitative methods (impressionistic classification of vessel designs) allow us to understand social practices of pottery production from the actors' perspective (micro level), quantitative methods (computational autoclassification of vessels shapes) make it possible to explore structural patterns of pottery consumption practice across several settlements (macro perspective). Through the combination of both perspectives, farreaching entanglements between regions become visible, as well as mobility-related local appropriations and transformations of pottery practices in the rhythm of decades. In this way, the usual culture historic models of homogenous societies can be deconstructed and replaced by entanglements between different communities of practice.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.relation.conference[].value
International Workshop 'Frontiers or Interaction Zones? Borderlands as areas of communication and mobility'

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
900 - History::930 - History of ancient world (to ca. 499)

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Pottery beyond Cultures - A praxeological Approach to Mobility, Entanglements and
Transformations in Prehistoric Societies

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.oairecerif.author.affiliation[].value
Institut für Archäologische Wissenschaften, Ur- und Frühgeschichte

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Brand Authenticity: an Integrative Framework

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
Although brand authenticity is gaining increasing interest in consumer behavior research and managerial practice, literature on its measurement and contribution to branding theory is still limited. This article develops an integrative framework of the concept of brand authenticity and reports the development and validation of a scale measuring consumers' perceived brand authenticity (PBA). A multi-phase scale development process resulted in a 15-item PBA scale measuring four dimensions: credibility, integrity, symbolism, and continuity. This scale is reliable across different brands and cultural contexts. We find that brand authenticity perceptions are influenced by indexical, existential, and iconic cues, whereby some of the latters' influence is moderated by consumers' level of marketing skepticism. Results also suggest that PBA increases emotional brand attachment and word-of-mouth, and that it drives brand choice likelihood through self-congruence for consumers high in self-authenticity.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.sponsorship[].value
Institut für Marketing und Unternehmensführung, Marketing

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
600 - Technology::650 - Management & public relations

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Brand Authenticity: an Integrative Framework

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.oairecerif.author.affiliation[].value
Institut für Marketing und Unternehmensführung, Marketing

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Assessing the reporting quality in abstracts of randomized controlled trials in leading journals of oral implantology.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
AIM

Abstracts of randomized clinical trials are extremely important as trial appraisal is often based on the information included here. The objective of this study was to assess the quality of the reporting of RCT abstracts in journals of Oral Implantology.

MATERIAL AND METHODS

Six leading Implantology journals were screened for RCTs between years 2008 and 2012. A 21-item modified CONSORT for abstracts checklist was used to examine the completeness of abstract reporting. Descriptive statistics and linear regression modeling were employed for data analysis.

RESULTS

One hundred and sixty three RCT abstracts were included in this study. The majority of the RCTs were published in the Clinical Oral Implants Research (42.9%). The mean overall reporting quality score was 58.6% (95% CI: 57.6-59.7). The highest score was noted in the European Journal of Oral Implantology (63.8%; 95% CI: 61.8-65.8). Multivariate analysis demonstrated that abstract quality score was related to publication journal and number of research centers involved. Most abstracts adequately reported interventions (89.0%), objectives (77.9%) and conclusions (74.8%) while failed to report randomization procedures, allocation concealment, effect estimate, confidence intervals, and funding. Registration of RCTs was not reported in any of the abstracts.

CONCLUSIONS

The reporting quality in abstracts of RCTs published in Oral Implantology journals needs to be improved. Editors and authors should be encouraged to endorse the CONSORT for abstracts guidelines in order to achieve optimal quality in abstract reporting.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.relation.ispartof[].value
Journal of evidence-based dental practice

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
600 - Technology::610 - Medicine & health

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Assessing the reporting quality in abstracts of randomized controlled trials in leading journals of oral implantology.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Supplemental cardioplegia immediately before graft implantation may improve early post-transplantation outcome

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
Gebiet:  Chirurgie Abstract:  Background: Preservation of cardiac grafts for transplantation is not standardized and most centers use a single administration of crystalloid solution at the time of harvesting. We investigated possible benefits of an additional dose of cardioplegia dispensed immediately before implantation. – – Methods: Consecutive adult cardiac transplantations (2005?2012) were reviewed. Hearts were harvested following a standard protocol (Celsior 2L, 4?8°C). In 2008, 100 ml crys-talloid cardioplegic solution was added and administered immediately before implanta-tion. Univariate and logistic regression analyses were used to investigate risk factors for post-operative graft failure and mid-term outcome. – – Results: A total of 81 patients, 44 standard (?Cardio???) vs. 37 with additional cardiople-gia (?CardioC?) were analyzed. Recipients and donors were comparable in both groups. CardioC patients demonstrated a reduced need for defibrillation (24 vs. 48%, p D0.03), post-operative ratio of CK-MB/CK (10.1_3.9 vs. 13.3_4.2%, p D0.001), intubation time (2.0_1.6 vs. 7.2_11.5 days, p D0.05), and ICU stay (3.9_2.1 vs. 8.5_7.8 days, p D0.001). Actuarial survival was reduced when graft ischemic time was >180 min in Cardio?? but not in CardioC patients (p D0.033). Organ ischemic time >180 min (OR: 5.48, CI: 1.08?27.75), donor female gender (OR: 5.84, CI: 1.13?33.01), and recipient/donor age >60 (OR: 6.33, CI: 0.86?46.75), but not the additional cardioplegia or the observation period appeared independent predictors of post-operative acute graft failure. – – Conclusion: An additional dose of cardioplegia administered immediately before implan-tation may be a simple way to improve early and late outcome of cardiac transplantation, especially in situations of prolonged graft ischemia.A large, ideally multicentric, randomized study is desirable to verify this preliminary observation.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Supplemental cardioplegia immediately before graft implantation may improve early post-transplantation outcome

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Care of the critically ill begins in the emergency medicine setting.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.contributor.author[].value
Critical Care in Emergency, Medicine Interest Group

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.note[].value
Critical Care in Emergency Medicine Interest Group: Exadaktylos, Aristomenis

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
600 - Technology::610 - Medicine & health

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Care of the critically ill begins in the emergency medicine setting.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.name
Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.description.abstract[].value
INTRODUCTION

The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains.

AIM OF THE STUDY

To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician.

METHODS

A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I2 and the QUADAS-2 tool was used to assess bias of the studies.

RESULTS

This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4-36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8-98.2%) and sensitivity of 86.7% (range 40-99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832-7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries.

CONCLUSION

Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases.

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject[].value
Blunt chest trauma Cardiac concussion Cardiac contusion Commotio cordis Contusio cordis Diagnostic protocol

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.subject.ddc[].value
600 - Technology::610 - Medicine & health

# _embedded.searchResult._embedded.objects[]._embedded.indexableObject.metadata.dc.title[].value
Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis.

# _embedded.facets[]._embedded.values[].label
300 - Social sciences, sociology & anthropology