Blunt Cardiac Injury in Patients With Sternal Fractures

Abstract

BackgroundBlunt cardiac injury (BCI) is a possible consequence of sternal fractures (SF). There is a scarcity of studies addressing BCI in patients with different types of SF and with pre-existing cardiac conditions. The goal of this study was to delineate diagnostic patterns of BCI in different cohorts of SF patients. MethodsThis retrospective cohort study included 380 blunt trauma patients admitted to two level 1 trauma centers between January 2015 and March 2020 with radiologically confirmed SF. Electrocardiography, cardiac enzymes and echocardiography were evaluated for BCI diagnosis. Analyzed variables included: age, comorbidities, injury severity score, Glasgow coma score, type of SF (isolated, combined, displaced), incidence of traumatic brain injury, co-injuries, retrosternal hematoma, intensive care unit admissions, hospital lengths of stay, and mortality. ResultsIn 380 SF patients there were 250 (66%) females and 130 (34%) males and the mean age was 63 years old. Electrocardiography was done in all patients, cardiac enzymes in 234 (62%) and echocardiography in 181 (48%). BCI was diagnosed in 19 (5%) of patients, all having combined SF. BCI patients had higher injury severity score (mean 18.4) and 14 (74%) had pulmonary co-injuries. Multivariable analysis confirmed pulmonary co-injuries as a statistically significant predictor of BCI (p<0.001). BCI patients compared to no BCI patients had all three tests (electrocardiography, cardiac enzymes and echocardiography) performed statistically more often (90% vs 36%, p<0.001). SF patients with pre-injury cardiac comorbidities had similar incidence of BCI as without cardiac comorbidities (5% vs 6%, p=0.6). In SF patients with traumatic brain injury, cardiac enzymes (troponin, creatine kinase) were elevated significantly more often compared to patients without traumatic brain injury (58% vs 38%, p=0.02). SF displacement or retrosternal hematoma presence were not associated with BCI. Mortality in SF patients with BCI versus without was not statistically different (16 vs 9%, p=0.4). ConclusionsBlunt cardiac injury is rare in patients with SF. Higher degree of BCI suspicion must be applied in combined SF patients, especially those with pulmonary co-injuries. Cardiac comorbidities did not affect the rate of BCI. Echocardiography for BCI diagnosis is essential in SF patients with traumatic brain injury, as cardiac enzymes may be less informative, however is less important in isolated SF patients. Performing all three diagnostic tests in combined SF patients improves the accuracy of BCI diagnosis.

Early Detection of Myocardial Contusion and Its Outcomes in Patients with Blunt Chest Trauma

“…The rate of death in the current research was 16.3% (25 cases). Our findings were comparable to those of Fokin et al (32) who reported a death rate of 16% in their BCI patients. This was in accordance with the findings of Keskpaik et al (22) who demonstrated that the total in-hospital death rate was 17.0 percent (25/147).…”

Management of Blunt Sternal Fractures in a Community-Based Hospital

“…The depth of sternal displacement is considered a sign of an increased risk of injury to adjacent structures such as the heart and lungs [ 18 ]. Similar to that reported in other studies, this study shows that 28 (44.4%) patients had some degree of sternal fracture displacement [ 19 ].…”

“…However, no statistically significant differences were observed in sternal fracture displacement between patients with multiple injuries and those with an isolated sternal fracture. The displaced sternal fractures are considered theoretically more dangerous, although previous studies have shown no statistically significant association between displaced fractures and the severity of blunt cardiac injuries or associated lung injuries [ 9 , 18 ]. Similar to the results reported in a previous study, sternal fractures occur most frequently in the body of the sternum, and no fractures have yet reported the involvement of the xiphisternum [ 20 ].…”

Factors Associated with Cardiac/Pericardial Injury among Blunt Injury Patients: A Nationwide Study in Japan

“…Sternal fractures were strongly associated with blunt cardiac injury. Previous studies reported sternal fractures in approximately 2% of blunt trauma cases [ 33 , 34 ], while in 2.4–8% of patients with sternal fractures, blunt cardiac injury were also observed [ 33 , 35 , 36 , 37 ]. Observational studies in the United States and Germany using large databases have also reported that sternal fracture is associated with blunt cardiac injury [ 1 , 2 ].…”