Low incidence of severe cardiac complications in traumatic sternal fractures: Rethinking routine rhythm monitoring

Blunt cardiac injury (BCI) is a common finding after traumatic sternal fracture. For suspected BCI, cardiac rhythm monitoring is generally advised. However, the risk of severe complications of BCI remains unclear. This study analysed the occurrence of severe cardiac complications among hospitalised sternal fracture patients.

A single-centre retrospective cohort study (January 2011 to December 2022) was conducted including adult blunt trauma patients with traumatic sternal fractures. Patients were excluded in case of non-blunt trauma, military status, transfer from another hospital > 24 h after trauma, transfer to another hospital during admission, or cardiopulmonary resuscitation prior to imaging. Primary outcome was the occurrence of severe cardiac complications, defined as sustained ventricular tachycardia, high-degree atrioventricular block, need for cardiac surgical intervention, primary cardiac arrest, or death from a primary cardiac cause. Secondary outcome was the occurrence of clinically relevant cardiac findings requiring treatment or outpatient follow-up.

Suspected BCI, defined as elevated troponin levels and/or ECG abnormalities within 6 h of presentation, occurred in 113 patients (32.3%). Two cases (2/113, 1.8%) of severe cardiac complications occurred in this group (both transient high-degree AV-block). Four patients (1.1%) developed cardiac arrest during admission due to a secondary non-cardiac cause. In total, 40 patients (11.4%) had clinically significant cardiac findings: 31 patients had new abnormalities, 7 patients showed changes in pre-existing cardiac conditions, and 2 patients had potential cardiac syncope as trauma cause. No major structural cardiac injury was found on echocardiography; 6 patients (1.7%) showed minor abnormalities on echocardiography.

Severe cardiac complications are rare after traumatic sternal fracture. Cardiac arrest occurred secondary to trauma-related, non-cardiac causes. These findings suggest that suspected BCI alone is not a sufficient indication for routine cardiac rhythm monitoring, and that admission to a monitored unit should be based on the patient's overall clinical condition. Non-urgent cardiac abnormalities were common, underlining the importance of cardiology consultation in these patients.