Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study

Abstract

Objective: The aim of this study was to determine the incidence of delayed complications, specifically hemothorax, and functional outcome in patients with isolated sternal fracture discharged from the emergency department (ED) compared to patients with other minor thoracic trauma. Methods: This prospective cohort study was conducted in four university-affiliated Canadian EDs. Patients ages 16 and older discharged from the ED with an isolated minor thoracic injury were included and categorized as isolated sternal fracture, rib fracture, or no fracture. A standardized clinical and radiological follow-up was performed at 7 and 14 days as well as a phone follow-up at 30 and 90 days post-injury. Functional outcome was determined using the Medical Outcome Short-Form Health Survey (SF-12). Results: A total of 969 patients were included, of whom 32 (3.3%) had an isolated sternal fracture, 304 (31.3%) had rib fracture, and 633 (65.3%) had no fracture. Within 14 days, 112 patients presented with a delayed hemothorax: 12.5% of sternal fracture patients, 23% of rib fracture(s) patients, and 6% of minor thoracic injury patients without fracture (p < 0.05). At 90 days, 57.1% of patients with sternal fracture had moderate to severe disability compared to 25.4% and 21.2% for both of the other groups, respectively (p < 0.001). Conclusion: In this prospective study, we found that 12.5% (n = 4, p < 0.05) of patients with sternal fracture developed a delayed hemothorax, but the clinical significance of this remains questionable. The proportion of patients with sternal fracture who had moderate to severe disability was significantly higher than that of patients with other minor thoracic trauma. RÉSUMÉObjectif: L'étude visait à déterminer l'incidence de complications tardives, précisément de l'hémothorax, et de résultats cliniques fonctionnels chez des patients ayant subi une fracture isolée du sternum, et ce après le congé du département d'urgence (DU), comparativement à des patients ayant subi d'autres traumas thoraciques mineurs. Méthode: Il s'agit d'une étude prospective de cohorte qui a été menée dans quatre DU rattachés à des centres hospitaliers universitaires au Canada. Des patients âgés de 16 ans et plus ayant obtenu leur congé du DU après avoir subi un traumatisme thoracique mineur isolé ont participé à cette étude; leur état a été catégorisé comme suit : fracture isolée du sternum, fracture(s) de côte(s) ou aucune fracture. Un suivi clinique et radiologique standardisé a été effectué au 7 e et 14 e jour, ainsi qu'un suivi téléphonique au 30 e et 90 e jour après l'accident. Les résultats cliniques fonctionnels ont été évalués selon le questionnaire Medical Outcomes Short-Form Health Survey (SF-12). Résultats: Au total, 969 patients ont participé à l'étude, dont 32 (3,3%) souffraient d'une fracture isolée du sternum; 304 (31,3%), d'une fracture(s) de côte(s) et 633 (65,3%), d'aucune fracture. Au cours des 14 jours suivants, 112 patients ont consulté pour un hémothorax retardé : 12,5% à la suite d'une fracture du ster...

SGEM Hot Off the Press: Delayed complications of sternal fractures

“…The Altmetric score, a proprietary, standardized tool that tracks the disseminative impact of research articles in social media forums (e.g., Facebook, Twitter) and on blogs, podcasts, and news outlets [20][21][22] , was also used. The Altmetrics of the featured article by Racine et al 3 were compared to all other articles published in CJEM and all published research analysed by Altmetric. 20 The discourse around this article was conducted entirely on the SGEM blog, with the link disseminated through Twitter and Facebook.…”

“…Eight comments were submitted to the blog from five original contributors, including feedback from the study's primary author Samuel Racine. 3 A few themes arose from the discussion, including uncertainty about the clinical relevance of end points, general comments about study methodology limitations, and the perception of good external validity among commenters (Table 4).…”

“…In this, the fifth SGEM HOP hosted collaboratively with CJEM, we discuss Racine et al's paper describing delayed complications and functional outcomes of isolated sternal fractures after emergency department discharge. 3…”

“…Racine et al 3 conducted a prospective cohort observational study in four university-affiliated hospitals in Montreal and Quebec City, Quebec. They compared delayed complications of sternal fractures with other minor thoracic traumatic injuries in those discharged directly from the emergency department.…”

Fraturas de esterno em uma unidade de tratamento intensivo especializada em trauma

“…Motor vehicle accident is the most common trauma mechanism and closed chest trauma is the predominant type of injury 1 . Within this subgroup of patients, sternum fractures were considered uncommon, with incidence ranging from 0.3% to 3.7% 3 . However, this incidence has been increasing in recent decades, fact which may be related to the increased use of seat belts 4 .…”