Sternal fractures in children: An analysis of the National Trauma Data Bank
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In brief
In brief
Retrospective analysis of 3,160 pediatric sternal fractures from NTDB (2007-2014) shows 90% occur in adolescents aged 12-18, with median ISS of 17 and 8% mortality. Poor outcomes correlate with associated injuries, lower GCS, and hemodynamic instability rather than the sternal fracture itself, emphasizing need for comprehensive trauma evaluation.
Written by the GCMD Library team from the article.
Purpose
The purpose of this study was to describe the epidemiology and evaluate the clinical significance of traumatic sternal fractures.
Methods
Patients age ≤18 years with sternal fractures in the National Trauma Database research datasets from 2007-2014 were identified. Patient demographics, injuries, procedures, and outcomes were analyzed using descriptive statistics and logistic regression.
Results
Three thousand one hundred sixty patients with sternal fracture were identified. Ninety percent of injuries occurred in patients between 12 and 18 years old. Median injury severity score (ISS) was 17 [9,29]. Exploratory thoracotomy was performed in 1%. Thirty-nine percent were admitted to the intensive care unit (ICU). On multivariate regression, predictors of ICU stay >1 day were increasing ISS, lack of the use of protective devices, decreasing Glasgow Coma Score (GCS), tachycardia, and pulmonary contusion. Median hospital length of stay was 4 [2, 9] days. In-hospital mortality was 8%. Predictors of mortality were lower GCS, increasing ISS, decreasing oxygen saturation, hypotension, and cardiac arrest. Use of protective devices and seat belts did not affect mortality.
Conclusion
Sternal fractures in patients increase in incidence with age, and poor outcomes are impacted by associated injuries and complications. The presence of a sternal fracture should trigger a careful diagnostic evaluation.
Level of Evidence
III
Study Type
Treatment Study