CARDIAC INVOLVEMENT IN SEAT-BELT-RELATED AND DIRECT STERNAL TRAUMA - A PROSPECTIVE-STUDY AND MANAGEMENT IMPLICATIONS

The study set out to asses the incidence and consequences of pericardi al and myocardial involvement in seatbelt-related sternal injury. Comp arison was made with that from direct sternal trauma and implications for patient management were examined. The study was designed as a pros pective sequential single centre study of 60 patients, from a total of 63 consecutive admissions over a 13 month period, admitted with blunt central chest trauma or multiple injuries involving the torso. Clinic al status, correlated with echocardiographic, ECG and cardiac enzyme a bnormalities were the main outcome measures. The study showed that 25% of 32 patients with seatbelt-related chest injury and 30% of 10 patie nts with multiple injuries had clinically unsuspected pericardial effu sions detected by echocardiography. Pericardial effusion was not assoc iated with an adverse outcome in the seatbelt-related injuries. Abnorm alities of ECG or CK-MB isoenzyme levels were non-specific and did not correlate with the presence of pericardial effusion. From these data it is concluded that seatbelt-related sternal trauma is usually relati vely benign. Echocardiography detects unsuspected pericardial effusion in a significant minority but ECG and cardiac enzyme estimations are of limited value. The routine admission to hospital of all patients wi th isolated seatbelt-related sternal trauma for cardiological monitori ng is unnecessary. Inpatient treatment should be reserved for patients whose clinical condition, social circumstances or other injuries nece ssitate admission.