Factors affecting discharge of patients with sternal fractures

Abstract

Aim: Sternal fractures, especially those due to motor vehicle accidents, are encountered in emergency department. There are no clear recommendations on discharge of patients with isolated sternal fractures from the emergency department. In this study, we aimed to examine the relationship between fracture type and severity of injury as well as factors affecting the decision of early discharge in case of sternal fractures detected in the emergency department. Materials and Methods: Patients who presented to the emergency department with trauma between 2014 and 2019 were retrospectively analyzed. Demographic characteristics, trauma mechanisms, additional injuries, injury severity scores, location of sternal fracture and displacement status, echocardiography findings, troponin I values, electrocardiography findings, duration of emergency department and hospital stay, and 30-day mortality of trauma patients aged above over 18 years with sternal fractures on thorax computed tomography included in the study were evaluated. Results: The mean age of 184 patients who were diagnosed with sternal fractures during the 5-year period was 49.9 ± 16.6 years, and 75.5% (n=139) of them were males. On examining the mechanisms of trauma, we found that the most common cause (63.5%; n=117) was motor vehicle accidents. The most common concomitant injuries were rib fractures (56.5%; n=104) and spinal fractures (44%; n=81). It was found that 73.9% (n=136) of sternal fractures were localized in the corpus and 63% (n=116) were non-displaced. It was determined that 33% (n = 61) of the patients were discharged from the emergency department, the mean duration of emergency department stay was 28.3 ± 24.3 hours, and the mean total hospitalization time was 9.8 ± 20.1 days. There was a significant relationship between the time to discharge with injury severity scores (ISS) and troponin I values of the patients. Conclusion:It should be noted that additional life-threatening injuries may be encountered more often in patients presenting with a high injury severity score (>15) and with a manubrium sterni fracture. In sternal fractures, early discharge from the emergency department can be considered in patients with a low injury severity scores (≤15) in whom no abnormal findings are detected in a follow-up performed with echocardiography, troponin I, electrocardiography, and constant monitoring.