A CROSS-SECTIONAL SURVEY OF CURRENT MANAGEMENT OF ISOLATED STERNAL FRACTURES IN THE UK: TIME FOR EVIDENCE BASED PRACTICE

Abstract

Objective: The practice of routine admission of isolated sternal fractures for observation is still widespread in the UK in spite of evidence to the contrary. We undertook a cross-sectional telephone survey of management of isolated sternal fractures in the UK.

Methods: We contacted 85 acute admitting units over a three month period and were able to get a response from 67 units.

Results: Most of the hospitals were district general hospitals (52) and situated in England (49)(Wales 4, Scotland 11, Northern Ireland 3). The orthopaedic department was the commonest admitting department (26) (General Surgery 19, Cardiothoracic Surgery 11, Accident & Emergency 9, Acute Medicine 2). 51 units would routinely admit isolated sternal fractures for observation. Other indications for admission include pain control (33), abnormal cardiac enzymes (28), social circumstances (23), abnormal electrocardiogram (6), and low oxygen saturation (5). Chest X-ray was performed on admission in all hospitals. 57 hospitals perform routine ECG and Cardiac enzymes prior to admission and 6 hospitals routinely carry out Echo-cardiogram subsequently. Patients were admitted for overnight observation and discharged the next day in all hospitals. Patients were not followed up on discharge except 3 units, where 2 hospitals with Cardio-thoracic unit would follow-up patients on discharge, and 1 hospital regularly advised GP follow-up.

Discussion: We found that the current practice of management of isolated sternal fractures in the UK did not conform to available evidence. A review of the literature indicated that patients with isolated sternal fractures are at low risk of significant cardiac, pulmonary or mediastinal complications and do not need extensive investigations or routine admission. In this instance, evidence based practice might help us to better utilise finite resources without jeopardising patient care.