Investigation of myocardial contusion with sternal fracture in the emergency department: multicentre review.

OBJECTIVE: To describe the use of initial electrocardiogram (ECG), follow-up ECG or equivalent monitoring, and troponin I in patients presenting with sternal fracture who are assessed in emergency departments or by front-line physicians.
DESIGN: Multicentre descriptive retrospective study.
SETTING: Two traumatology teaching centres in Quebec city, Que. PARTICIPANTS: Fifty-four trauma patients presenting with sternal fracture.
INTERVENTIONS: Assessment of the use of initial ECG, ECG or equivalent monitoring 6 hours after trauma, and troponin administration. MAIN OUTCOME MEASURES: In terms of ECG use, quality comparison criteria were selected on the basis of expert opinions in 4 studies. An initial ECG and a follow-up ECG 6 hours after trauma or cardiac monitoring 6 hours after trauma were recommended by most authors for diagnosing myocardial contusion in cases of sternal fracture. Serum troponin I administered 4 to 8 hours after chest trauma was also recommended by some as an effective means of detecting substantial arrhythmia secondary to myocardial contusion. Descriptive univariate analyses and tests were performed. A P < .05 was considered significant.
RESULTS: Thirty-nine patients (72%) were assessed initially with ECGs; after 6 hours in the emergency department, 18 of these patients (33%) had follow-up ECGs or equivalent cardiac monitoring. Sixteen patients (30%) were assessed by means of troponin I dosage. Two patients (4%) presented with ECG abnormalities and only 1 patient (2%) presented with an elevated troponin I level.
CONCLUSION: Emergency physicians must increase their use of ECG in initial or follow-up diagnosis for trauma patients presenting with sternal fracture to detect myocardial contusion and arrhythmia. The use of troponin in conjunction with ECG is also suggested for this population in order to identify patients at risk of complications secondary to myocardial contusion.