J. S. Lozada1, A. T. Abid2,3, K. Yoshinaga2,3, R. Grady2,3, A. L. Alayon2,3, J. Wycech1,3, A. A. Fokin2,3, I. Puente1,2,3,4 1Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 2Florida Atlantic University,Charles E Schmidt College Of Medicine,Boca Raton, FL, USA 3Delray Medical Center,Trauma Services,Delray Beach, FL, USA 4Florida International University,Herbert Wertheim College Of Medicine,Miami, FL, USA
Introduction:
Due to the rarity of sternal fractures (SF), data examining the relationship of cardiac contusion (CC) in patients with SF is scarce. The aim of this study was to characterize patients with SF who were diagnosed with a CC.
Methods:
This retrospective cohort analysis included 404 adult (≥18 years old) patients with SF who were treated at two level I trauma centers between January 2015 and May 2020. Patients were compared in two groups: with diagnosed cardiac contusion (CC) n=86, or without cardiac contusion (WCC) n=318. CC was defined as the presence of an abnormal electrocardiogram in conjunction with elevated cardiac enzymes, or as a wall motion abnormality seen during an echocardiogram. Analyzed variables included: age, comorbidities, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), pulmonary co-injuries, SF pattern, sternal and cardiac procedures, ventilation requirements (including tracheostomy rates), ICU admissions, ICU length of stay (ICULOS), hospital LOS (HLOS), and mortality.
Results:
CC was diagnosed in 21.3% of patients with SF. Mean age in CC patients was 67.4, while in WCC patients it was 60.1 (p=0.004), with a significantly higher prevalence of geriatric population (≥ 65 y.o.) in the CC group (65.1% vs 45.9%, p=0.002). Comorbidities (94.0% vs 80.2%, p=0.02) and particularly cardiac comorbidities (atrial fibrillation, coronary artery disease, hypertension) were more common in CC patients (73.5% vs 48.2%, p=0.001) [Fig. 1]. ISS (15.5 vs 13.2), GCS (13.2 vs 14.0), and SF pattern (body, manubrium, dual, isolated, combined) were similar in CC and WCC groups, all p>0.1. Pulmonary co-injuries (45.3% vs 31.4%, p=0.02) and particularly pulmonary contusion were significantly more common among CC patients (29.1% vs 18.2%, p=0.03). Sternal plating procedure rate was not different (5.8% vs 12.3%, p=0.09), while cardiac procedures were statistically more common in the CC group (8.1% vs 2.2%, p=0.008). Ventilation requirements (33.7% vs 20.8%, p=0.01) and tracheostomy rates (16.3% vs 4.7%, p<0.001) were higher in CC patients. The CC group was admitted to the ICU more often (75.6% vs 50.3%, p<0.001), but ICULOS was not statistically different (8.7 vs 6.3 days, p=0.09). CC patients had an increased HLOS (13.9 vs 8.9 days, p=0.02), and a statistically higher mortality (14.0% vs 6.0%, p=0.03).
Conclusion:
Although the patterns and severity of sternal injury in itself were similar, patients with cardiac contusion had higher mechanical ventilation requirements and mortality rates, which could be attributed to their cardiac trauma, advanced age and pulmonary co-injuries. Thus, patients with a sternal fracture and cardiac comorbidities should be thoroughly screened for possible cardiac contusion.
