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Al-Khouja F, Paladugu A, Ruiz A, Prentice K, Kirby K, Santos J, Rockne W, Nahmias J. Evaluating the Need for Prolonged Telemetry Monitoring in Patients With Isolated Sternal Fractures. J Surg Res 2022; 280:320-325. [PMID: 36030608 DOI: 10.1016/j.jss.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/31/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Isolated sternal fractures (ISFs) often result from deceleration or chest wall trauma. Current guidelines recommend screening ISF patients for blunt cardiac injury (BCI) with electrocardiogram (ECG) and troponin. If either is abnormal, 24-h telemetry monitoring is recommended. This study sought to determine if ISF patients with abnormal ECG will manifest any cardiac-related complications within 6 h of hospital arrival. METHODS A retrospective study was performed at a single level I trauma center. Patients with diagnosed sternal fracture and an Abbreviated Injury Scale <2 for head/neck, face, abdomen, and extremities were included. Patients with multiple rib fractures or hemopneumothorax were excluded. Demographic data, ECG, troponin, and echocardiogram results were collected. The primary outcome was cardiac-related complications or procedures. Complications included hypotension, arrhythmia, and hemodynamic instability. Procedures included sternal stabilization, cardiac catheterization, or sternotomy/thoracotomy. Descriptive statistics were performed. RESULTS One hundred twenty-nine ISF patients were evaluated, 68 (52.7%) had an ECG abnormality. Eight patients had elevated troponin (6.2%). One patient (0.78%) suffered a cardiac-related complication (arrhythmia); however, this was 82 h into hospitalization. Two patients suffered noncardiac complications (urinary tract infection and acute kidney injury) (1.55%). Three patients had echocardiogram abnormality (2.33%), but no patients sustained a BCI or underwent a BCI-related procedure. CONCLUSIONS After ISF, <1% of patients suffered a cardiac-related complication and none had BCI. These findings suggest 24-h monitoring for patients with ISF and abnormal ECG may be unnecessarily long. A prospective multicenter study to evaluate the validity of these results is needed prior to change of practice.
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Affiliation(s)
- Fares Al-Khouja
- University of California, Irvine (UCI), Department of Surgery, Orange, California
| | - Anushka Paladugu
- University of California, Irvine (UCI), Department of Surgery, Orange, California
| | - Andres Ruiz
- University of California, Irvine (UCI), Department of Surgery, Orange, California
| | - Kylie Prentice
- University of California, Irvine (UCI), Department of Surgery, Orange, California
| | - Kate Kirby
- University of California, Irvine (UCI), Department of Surgery, Orange, California
| | - Jeffrey Santos
- University of California, Irvine (UCI), Department of Surgery, Orange, California
| | - Wendy Rockne
- University of California, Irvine (UCI), Department of Surgery, Orange, California
| | - Jeffry Nahmias
- University of California, Irvine (UCI), Department of Surgery, Orange, California.
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Sadamatsu K, Sagara S, Oe K, Tashiro H, Yasunaga H. Meteorological and chronobiological factors and the occurrence of acute aortic dissection. Heart Vessels 2020; 35:1003-1011. [PMID: 32108242 DOI: 10.1007/s00380-020-01569-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/14/2020] [Indexed: 12/01/2022]
Abstract
Although a number of studies have demonstrated seasonal variations in acute cardiovascular events, the association between winter and low temperatures and the incidence rate of acute aortic dissection has not been fully elucidated. In this study, we investigated the association between meteorological and chronobiological factors and the occurrence of acute aortic dissection classified by the Stanford type, sex and age. We retrospectively collected 131 patients who had been admitted consecutively to our institution with acute aortic dissection, including 58 type A patients and 73 type B patients, from January 2013 to December 2017. The meteorological data were downloaded from the homepage of the Japan Meteorological Agency. The daily incidence of aortic dissection was higher in winter (10.2%) than in fall (5.3%) (P = 0.04), and a significant winter peak was also observed in the sub-groups of males and type B, while there were no significant differences in the proportions of type A, female, and ≤ 70- and > 70-year-old patients. The maximum, mean and minimum temperatures on the days with aortic dissection were significantly lower than on the days without aortic dissection. Divided into four seasons, lower temperatures were found only in spring. The most significant and greatest difference was observed between the maximum temperature on the day of aortic dissection and that at 2 days earlier. The multivariate logistic regression analysis showed that the difference in the maximum temperature between the day of and 2 days before the incident (odds ratio 0.91; 95% confidence interval 0.87-0.96; P < 0.01) as well as the maximum temperature (odds ratio 0.97; 95% confidence interval 0.95-0.99; P = 0.02) were significantly associated with the incidence of aortic dissection. Cold weather and a sudden decrease in temperature might trigger aortic dissection, although the influence might differ among sub-groups.
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Affiliation(s)
- Kenji Sadamatsu
- Department of Cardiology, St. Mary's Hospital, Kurume, Japan.
| | | | - Kensuke Oe
- Department of Cardiology, St. Mary's Hospital, Kurume, Japan
| | - Hideki Tashiro
- Department of Cardiology, St. Mary's Hospital, Kurume, Japan
| | - Hiroshi Yasunaga
- Department of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan
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Al-Thani H, Jabbour G, El-Menyar A, Wahlen BM, Asim M, Abdelrahman H, Nabir S, Al-Jogol H, Mahmood I, El-Faramawy A, Parchani A, Afifi I, Peralta R. Traumatic sternal injury in patients with rib fracture: A single-center experience. Int J Crit Illn Inj Sci 2019; 9:75-81. [PMID: 31334049 PMCID: PMC6625325 DOI: 10.4103/ijciis.ijciis_67_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: We aimed to assess the pattern and impact of sternal injury with rib fracture in a Level 1 trauma center. Patients and Methods: We conducted a retrospective review of trauma registry data to identify patients who presented with sternal fracture between 2010 and 2017. Data were analyzed and compared in patients with and without rib fracture. Results: We identified 212 patients with traumatic sternal injury, of them 119 (56%) had associated rib fractures. In comparison to those who had no rib fracture, patients with rib fractures were older (40.1 ± 13.6 vs. 37.8 ± 14.5), were frequently involved in traffic accidents (75% vs. 71%), had higher chest abbreviated injury scale (AIS 2.8 ± 0.6 vs. 2.2 ± 0.5) and Injury Severity Score ( ISS 17.5 ± 8.6 vs. 13.3 ± 9.6), were more likely to be intubated (33% vs. 19%), required chest tube insertion (13.4% vs. 4.3%), and received blood transfusion (29% vs. 17%). Rates of spine fracture, head injury, and solid organ injury were comparable in the two groups. Manubrium, clavicular and scapular fractures, lung contusion, hemothorax, and pneumothorax were significantly more evident in those who had rib fractures. Hospital length of stay was prolonged in patients with rib fractures (P = 0.008). The overall mortality was higher but not statistically significant in patients with rib fractures (5.0% vs. 3.2%). Conclusions: Sternal fractures are rare, and detection of associated injuries requires a high index of suspicion. Combined sternal and rib fractures are more evident in relatively older patients after chest trauma. This combination has certain clinical implications that necessitate further prospective studies.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Gaby Jabbour
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.,Department of Medicine, Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Bianca M Wahlen
- Department of Anesthesia, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Syed Nabir
- Radiology, Hamad General Hospital, Doha, Qatar
| | - Hisham Al-Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ismail Mahmood
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmed El-Faramawy
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ibrahim Afifi
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Majd P, Madershahian N, Sabashnikov A, Weber C, Ahmad W, Weymann A, Heinen S, Merkle J, Eghbalzadeh K, Wippermann J, Brunkwall J, Wahlers T. Impact of meteorological conditions on the incidence of acute aortic dissection. Ther Adv Cardiovasc Dis 2018; 12:321-326. [PMID: 30244647 DOI: 10.1177/1753944718801559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: There is still much controversy about whether meteorological conditions influence the occurrence of acute aortic dissection (AAD). The aim of the present study was to investigate the possible correlation between atmospheric pressure, temperature, lunar cycle and the event of aortic dissection in our patient population. METHODS: The clinical data for 348 patients with AAD (73% type Stanford A) were confronted with the meteorological data provided by the Cologne weather station over the same period. RESULTS: There were no statistically significant differences between meteorological parameters on days of AAD events compared with control days. A logistic regression model showed that air pressure (odds ratio [OR] 1.004, 95% confidence interval [CI] 0.991-1.017, p = 0.542), air temperature (OR 0.978, 95% CI 0.949-1.008, p = 0.145), season ( p = 0.918) and month of the event ( p = 0.175) as well as presence of full moon (OR 1.579, 95% CI 0.763-3.270, p = 0.219) were not able to predict AAD events. Also, no predictive power of meteorological data and season was found on analysing their impact on different types of AAD events. CONCLUSIONS: Our study did not reveal any dependence of atmospheric pressure, air temperature or the presence of full moon on the incidence of different types of AAD.
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Affiliation(s)
- Payman Majd
- Department of Vascular Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Navid Madershahian
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Wael Ahmad
- Department of Vascular Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Stephanie Heinen
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Julia Merkle
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Jens Wippermann
- Department of Cardiothoracic Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jan Brunkwall
- Department of Vascular Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
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