About time re: Sternal #s

Thanks to JournalWatch for this update: Isolated Sternal Fractures May Not Warrant Hospital Admission Richard D. Zane, MD, FAAEM Reviewing Odell DD et al., J Trauma Acute Care Surg 2013 Sep 75:448 Most patients can be safely discharged after emergency department evaluation.

Sternal fractures are usually associated with high-energy trauma. Conventional wisdom has been that patients with sternal fractures require hospitalization because of the injury mechanism (usually motor vehicle crash), potential for occult associated injury, and severity of pain. In this retrospective study of 1867 patients with sternal fracture who were admitted to Israeli trauma centers over a 12-year period, the authors compared in-hospital events between patients with isolated sternal fractures (26%) and those with sternal fractures associated with other injuries (polytrauma; 73%). Patient characteristics and mechanisms of injury (mostly motor vehicle collisions and falls from significant height) were similar in the two groups. Compared with patients with polytrauma, those with isolated sternal fractures less frequently exhibited tachycardia, hypotension, tachypnea, Glasgow Coma Scale score ≤14, and Revised Trauma Score ≤11. No patients with isolated sternal fracture required endotracheal intubation, chest tube, thoracoscopy, or resuscitative thoracotomy; these procedures were performed in 17% of patients with polytrauma. EDITOR DISCLOSURES AT TIME OF PUBLICATION Disclosures for Richard D. Zane, MD, FAAEM at time of publicationEditorial boardsPocket Emergency Medicine CITATION(S): Odell DD et al. Sternal fracture: Isolated lesion versus polytrauma from associated extrasternal injuries — Analysis of 1,867 cases. J Trauma Acute Care Surg 2013 Sep; 75:448. (http://dx.doi.org/10.1097/TA.0b013e31829e227e)