title: Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study.
abstract: OBJECTIVE
  The aim of this study was to determine the incidence of delayed complications, specifically hemothorax, and functional outcome in patients with isolated sternal fracture discharged from the emergency department (ED) compared to patients with other minor thoracic trauma.
  
  
  METHODS
  This prospective cohort study was conducted in four university-affiliated Canadian EDs. Patients ages 16 and older discharged from the ED with an isolated minor thoracic injury were included and categorized as isolated sternal fracture, rib fracture, or no fracture. A standardized clinical and radiological follow-up was performed at 7 and 14 days as well as a phone follow-up at 30 and 90 days post-injury. Functional outcome was determined using the Medical Outcome Short-Form Health Survey (SF-12).
  
  
  RESULTS
  A total of 969 patients were included, of whom 32 (3.3%) had an isolated sternal fracture, 304 (31.3%) had rib fracture, and 633 (65.3%) had no fracture. Within 14 days, 112 patients presented with a delayed hemothorax: 12.5% of sternal fracture patients, 23% of rib fracture(s) patients, and 6% of minor thoracic injury patients without fracture (p<0.05). At 90 days, 57.1% of patients with sternal fracture had moderate to severe disability compared to 25.4% and 21.2% for both of the other groups, respectively (p<0.001).
  
  
  CONCLUSIONS
  In this prospective study, we found that 12.5% (n=4, p<0.05) of patients with sternal fracture developed a delayed hemothorax, but the clinical significance of this remains questionable. The proportion of patients with sternal fracture who had moderate to severe disability was significantly higher than that of patients with other minor thoracic trauma.
authors.affiliation: *Axe santé des populations et pratiques optimales en santé,Centre de recherche du CHU de Québec,Hôpital de l'Enfant-Jésus,Québec,QC.
authors.forename: Samuel
authors.initials: S
authors.lastname: Racine
authors.affiliation: *Axe santé des populations et pratiques optimales en santé,Centre de recherche du CHU de Québec,Hôpital de l'Enfant-Jésus,Québec,QC.
authors.forename: Marcel
authors.initials: M
authors.lastname: Émond
authors.affiliation: ¶Centre hospitalier régional de Lanaudière,Joliette,QC.
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Audette-Côté
authors.affiliation: *Axe santé des populations et pratiques optimales en santé,Centre de recherche du CHU de Québec,Hôpital de l'Enfant-Jésus,Québec,QC.
authors.forename: Natalie
authors.initials: N
authors.lastname: Le Sage
authors.affiliation: †Département de médecine familiale et de médecine d'urgence,Université Laval,Québec,QC.
authors.forename: Chantal
authors.initials: C
authors.lastname: Guimont
authors.affiliation: *Axe santé des populations et pratiques optimales en santé,Centre de recherche du CHU de Québec,Hôpital de l'Enfant-Jésus,Québec,QC.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.affiliation: ‡Centre hospitalier du Sacré-Cœur de Montréal,Montréal,QC.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chauny
authors.affiliation: *Axe santé des populations et pratiques optimales en santé,Centre de recherche du CHU de Québec,Hôpital de l'Enfant-Jésus,Québec,QC.
authors.forename: Éric
authors.initials: É
authors.lastname: Bergeron
authors.affiliation: §Centre hospitalier de Charles-LeMoyne,Greenfield Park,Longueuil,QC.
authors.forename: Laurent
authors.initials: L
authors.lastname: Vanier
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D002170:Canada; D016009:Chi-Square Distribution; D015331:Cohort Studies; D057210:Delayed Diagnosis; D004185:Disability Evaluation; D004636:Emergency Service, Hospital; D005260:Female; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis; D006491:Hemothorax / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D020127:Recovery of Function; D012253:Rib Fractures / Q000150:complications / Q000175:diagnosis; D018570:Risk Assessment; D013249:Sternum / Q000293:injuries*; D013898:Thoracic Injuries / Q000150:complications / Q000175:diagnosis / Q000628:therapy
keywords: delayed complications; delayed hemothorax; funtionnal outcome; isolated sternal fracture; minor thoracic trauma