title: Sternal fracture in the age of pan-scan.
abstract: OBJECTIVE
  Widespread chest CT use in trauma evaluation may increase the diagnosis of minor sternal fracture (SF), making former teaching about SF obsolete. We sought to determine: (1) the frequency with which SF patients are diagnosed by CXR versus chest CT under current imaging protocols, (2) the frequency of surgical procedures related to SF diagnosis, (3) SF patient mortality and hospital length of stay comparing patients with isolated sternal fracture (ISF) and sternal fracture with other thoracic injury (SFOTI), and (4) the frequency and yield of cardiac contusion (CC) workups in SF patients.
  
  
  METHODS
  We analyzed charts and data of all SF patients enrolled from January 2009 to May 2013 in the NEXUS Chest and NEXUS Chest CT studies, two multi-centre observational cohorts of blunt trauma patients who received chest imaging for trauma evaluation.
  
  
  RESULTS
  Of the 14,553 patients in the NEXUS Chest and Chest CT cohorts, 292 (2.0%) were diagnosed with SF, and 94% of SF were visible on chest CT only. Only one patient (0.4%) had a surgical procedure related to SF diagnosis. Cardiac contusion was diagnosed in 7 (2.4%) of SF patients. SF patient mortality was low (3.8%) and not significantly different than the mortality of patients without SF (3.1%) [mean difference 0.7%; 95% confidence interval (CI) -1.0 to 3.5%]. Only 2 SF patient deaths (0.7%) were attributed to a cardiac cause. SFOTI patients had longer hospital stays but similar mortality to patients with ISF (mean difference 0.8%; 95% CI -4.7% to 12.0).
  
  
  CONCLUSIONS
  Most SF are seen on CT only and the vast majority are clinically insignificant with no change in treatment and low associated mortality. Workup for CC in SF patients is a low-yield practice. SF diagnostic and management guidelines should be updated to reflect modern CT-driven trauma evaluation protocols.
authors: Department of Emergency Medicine, The University of California San Francisco, United States. Electronic address: Michael.Perez@ucsf.edu.
authors: Michael R
authors: MR
authors: Perez
authors: Department of Emergency Medicine, The University of California San Francisco, United States.
authors: Robert M
authors: RM
authors: Rodriguez
authors: Department of Emergency Medicine, Cooper Medical School of Rowan University, United States.
authors: Brigitte M
authors: BM
authors: Baumann
authors: Department of Emergency Medicine, University of California Irvine, United States.
authors: Mark I
authors: MI
authors: Langdorf
authors: Department of Emergency Medicine, Keck School of Medicine - University of Southern California, United States.
authors: Deirdre
authors: D
authors: Anglin
authors: Department of Emergency Medicine, The University of Texas Health Science Center at Houston, United States.
authors: Richard N
authors: RN
authors: Bradley
authors: University of California San Diego School of Medicine, Department of Emergency Medicine, United States.
authors: Anthony J
authors: AJ
authors: Medak
authors: Department of Emergency Medicine, University of California Los Angeles, United States.
authors: William R
authors: WR
authors: Mower
authors: Department of Emergency Medicine, University of California San Francisco Fresno Medical Education Program, United States.
authors: Gregory W
authors: GW
authors: Hendey
authors: Department of Emergency Medicine, University of California Davis, United States.
authors: Daniel K
authors: DK
authors: Nishijima
authors: Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School, United States.
authors: Ali S
authors: AS
authors: Raja
mesh_terms: D003661:Decision Support Techniques; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000209:etiology; D006335:Heart Injuries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D006801:Humans; D015601:Injury Severity Score; D064887:Observational Studies as Topic; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000639:trends*; D012680:Sensitivity and Specificity; D013249:Sternum / Q000000981:diagnostic imaging / Q000293:injuries*; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000639:trends*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality
keywords: Cardiac contusion; NEXUS Chest; Sternal fracture; Trauma imaging