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 of pericardial and myocardial involvement in seatbelt-related sternal injury. Comparison was made with that from direct sternal trauma and implications for patient management were examined. The study was designed as a prospective 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. Clinical status, correlated with echocardiographic, ECG and cardiac enzyme abnormalities were the main outcome measures. The study showed that 25% of 32 patients with seatbelt-related chest injury and 30% of 10 patients with multiple injuries had clinically unsuspected pericardial effusions detected by echocardiography. Pericardial effusion was not associated with an adverse outcome in the seatbelt-related injuries. Abnormalities 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 relatively 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 with isolated seatbelt-related sternal trauma for cardiological monitoring is unnecessary. Inpatient treatment should be reserved for patients whose clinical condition, social circumstances or other injuries necessitate admission.