Evaluating the Need for Prolonged Telemetry Monitoring in Patients With Isolated Sternal Fractures

Introduction: Isolated sternal fractures (ISFs) often result from deceleration or chest wall trauma. Current guidelines recommend screening ISF patients for blunt cardiac injury (BCI) with electrocardiogram (ECG) and troponin. If either is abnormal, 24-h telemetry monitoring is recommended. This study sought to determine if ISF patients with abnormal ECG will manifest any cardiac-related complications within 6 h of hospital arrival.

Methods: A retrospective study was performed at a single level I trauma center. Patients with diagnosed sternal fracture and an Abbreviated Injury Scale <2 for head/neck, face, abdomen, and extremities were included. Patients with multiple rib fractures or hemopneumothorax were excluded. Demographic data, ECG, troponin, and echocardiogram results were collected. The primary outcome was cardiac-related complications or procedures. Complications included hypotension, arrhythmia, and hemodynamic instability. Procedures included sternal stabilization, cardiac catheterization, or sternotomy/thoracotomy. Descriptive statistics were performed.

Results: One hundred twenty-nine ISF patients were evaluated, 68 (52.7%) had an ECG abnormality. Eight patients had elevated troponin (6.2%). One patient (0.78%) suffered a cardiac-related complication (arrhythmia); however, this was 82 h into hospitalization. Two patients suffered noncardiac complications (urinary tract infection and acute kidney injury) (1.55%). Three patients had echocardiogram abnormality (2.33%), but no patients sustained a BCI or underwent a BCI-related procedure.

Conclusions: After ISF, <1% of patients suffered a cardiac-related complication and none had BCI. These findings suggest 24-h monitoring for patients with ISF and abnormal ECG may be unnecessarily long. A prospective multicenter study to evaluate the validity of these results is needed prior to change of practice.