Airbag Deployment as a Trigger for Blunt Cardiac Injury Screening: A Nationwide Trauma Analysis

Background Blunt cardiac injury (BCI) after motor vehicle collisions (MVCs) is potentially life-threatening yet easily missed. We evaluated whether airbag deployment, an observation readily available in the trauma bay, can heighten suspicion for BCI and lower the threshold for cardiac screening. Methods We performed a retrospective analysis of the ACS-TQIP database (2017-2021). Adult patients (≥16 years) involved in MVCs were stratified by airbag deployment status (AB vs NoAB). Multivariable logistic regression was used to assess the association between airbag deployment and BCI. Results Airbag deployment occurred in 424,912 patients (81.5%). AB was independently associated with an increased likelihood of BCI (OR 1.16, 95% CI 1.07-1.26; p < 0.001). Sternal fracture (OR: 3.23; 95% CI: 3.03-3.44; p < 0.001), sternal contusion without fracture (OR: 2.67; 95% CI: 1.71-4.14; p < 0.001), congestive heart failure (OR 1.24, 95% CI 1.05-1.46; p = 0.013), and prior myocardial infarction (OR 1.40, 95% CI 1.02-1.92; p = 0.039) were associated with increased risk of BCI. Discussion Airbag deployment was independently associated with BCI, including in low-severity trauma. Although the effect size was modest, airbag deployment is a known on arrival finding that, together with sternal injury, physiologic derangement, and cardiac biomarkers, may help identify patients who warrant BCI screening even when overall injury severity appears low. Level of evidence Level III retrospective study.