Cardiac involvement in seatbelt-related and direct sternal trauma: a prospective study and management implications

The study set out to assess the incidence and consequences ofpericardial and myocardial involvement in seatbelt-related sternalinjury. Comparison was made with that from direct sternal traumaand implications for patient management were examined The study was designed as a prospective sequential single centrestudy of 60 patients, from a total of 63 consecutive admissionsover a 13 month period, admitted with blunt central chest traumaor multiple injuries involving the torso. Clinical status, correlatedwith echo cardiographic, ECG and cardiac enzyme abnormalitieswere the main outcome measures. The study showed that 25% of 32 patients with seatbelt-relatedchest injury and 30% of 10 patients with multiple injuries hadclinically unsuspected pericardial effusions detected by echocardiography.Pericardial effusion was not associated with an adverse outcomein the seatbelt-related injuries. Abnormalities of ECG or CK-MBisoenzyme levels were non-specific and did not correlate withthe presence of pericardial effusion. From these data it is concluded tliat seatbelt-related sternaltrauma is usually relatively benign. Echocardiography detectsunsuspected pericardial effusion in a significant minority butECG and cardiac enzyme estimations are of limited value. Theroutine admission to hospital of all patients with isolatedseatbelt-related sternal trauma for cardiological monitoringis unnecessary. Inpatient treatment should be reserved for patientswhose clinical condition, social circumstances or other injuriesnecessitate admission.