BET 3: Bedside ultrasound for the diagnosis of sternal fracture.

A shortcut review was carried out to establish whether ultrasound is an effective diagnostic tool for the diagnosis of sternal fractures. 27 papers were found of which 4 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. The clinical bottom line is that in patients with blunt thoracic injury and suspected isolated sternal fracture, ultrasound seems superior to conventional radiology to diagnose sternal fracture.

L'échographie équivaut-elle à la tomodensitométrie dans la prise en charge des patients avec suspicion d'urolithiase se présentant à l'urgence?

ARTICLE CHOSEN: Smith-Bindman R, Aubin C, Bailitz J., et al. Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis. New Engl J Med 2014;371;1100-10.

Delayed complications and functional outcome of isolated sternal fracture after emergency department discharge: a prospective, multicentre cohort study.

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). CONCLUSION: 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.