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

  • Samuel Racine (a1) (a2) (a3), Marcel Émond (a1) (a2) (a3), Jean-Sébastien Audette-Côté (a4), Natalie Le Sage (a1) (a2) (a3), Chantal Guimont (a2) (a3), Lynne Moore (a1) (a3), Jean-Marc Chauny (a5), Éric Bergeron (a1) (a6) and Laurent Vanier (a6)...
Abstract
AbstractObjective

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 7e et 14e jour, ainsi qu’un suivi téléphonique au 30e et 90e 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 sternum; 23% à la suite d’une fracture(s) de côte(s) et 6% à la suite de traumatisme thoracique mineur sans fracture (p<0,05). Au bout de 90 jours, 57,1% des patients ayant subi une fracture du sternum présentaient une incapacité modérée ou grave par rapport à 25,4% et 21,2% dans les deux autres groupes, respectivement (p<0,001).

Conclusions

Les résultats de cette étude prospective démontrent qu’un hémothorax retardé s’est formé chez 12,5% (n=4; p<0,05) des patients ayant subi une fracture du sternum, mais la portée clinique de cette complication reste discutable. Une incapacité modérée ou grave a été observée dans une proportion significativement plus grande de patients ayant subi une fracture du sternum que de patients ayant subi d’autres traumas thoraciques mineurs.

Copyright
Corresponding author
Correspondence to: Dr. Marcel Émond, Emergency Department, CHU de Québec, Hôpital de l’Enfant-Jésus, 1401, 18e Rue, Room H-607, Québec, QC G1J 1Z4; Email: marcelemond1@me.com.
Linked references
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Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
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