{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:57:20Z","timestamp":1785128240502,"version":"3.55.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current guidelines recommend 24-hour telemetry monitoring for isolated sternal fractures (ISFs) with electrocardiogram (ECG) abnormalities or troponin elevation. However, a single-center study suggested ISF patients with minor ECG abnormalities (sinus tachycardia\/bradycardia, nonspecific arrhythmia\/ST-changes, and bundle branch block) may not require 24-hour telemetry monitoring. This study sought to corroborate this, hypothesizing ISF patients would not develop blunt cardiac injury (BCI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials &amp; Methods<\/jats:title>\n                    <jats:p>A retrospective study was performed at 8 trauma centers (1\/2018-8\/2020). Patients with ISF (abbreviated injury scale &lt;2 for the head\/neck\/face\/abdomen\/extremities) and minor ECG abnormalities or troponin elevations were included. Patients with multiple rib fractures or hemothorax\/pneumothorax were excluded. The primary outcome was an echocardiogram confirmed BCI. The secondary outcome was significant BCI defined as cardiogenic shock, dysrhythmia requiring treatment, post-traumatic cardiac structural defects, unexplained hypotension, or cardiac-related procedures. Descriptive statistics were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 124 ISF patients with minor ECG abnormalities or troponin elevation, 90% were admitted with a mean stay of 35 hours. Echocardiogram was performed for 31.5% of patients, 10 (25.6%) of which had abnormalities. However, no patient had BCI diagnosed on echocardiography. In total, 2 patients (1.6%) had a significant BCI (atrial fibrillation and supraventricular tachycardia at 10 and 82\u00a0hours after injury). No patient died.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Following ISF with minor ECG changes or troponin elevation, &lt;2% suffered significant BCI, and none had an echocardiogram diagnosed BCI, despite &gt;30% receiving echocardiogram. These findings challenge the dogma of mandatory observation periods following ISF with associated ECG abnormalities and support the lack of utility for routine echocardiography in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348241278904","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T22:01:30Z","timestamp":1724796090000},"page":"126-132","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["24-hour Telemetry Monitoring May Not be Necessary for Patients With an Isolated Sternal Fracture and Minor ECG Abnormalities or Troponin Elevation: A Southern California Multicenter Study"],"prefix":"10.1177","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5784-6267","authenticated-orcid":false,"given":"Fares","family":"Al-Khouja","sequence":"first","affiliation":[{"name":"Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areg","family":"Grigorian","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent","family":"Emigh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Los Angeles County\/University of Southern California Medical Center, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5743-596X","authenticated-orcid":false,"given":"Morgan","family":"Schellenberg","sequence":"additional","affiliation":[{"name":"Department of Surgery, Los Angeles County\/University of Southern California Medical Center, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graal","family":"Diaz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ventura County Medical Center, Ventura, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas K.","family":"Duncan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ventura County Medical Center, Ventura, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Tuli","sequence":"additional","affiliation":[{"name":"Comparative Effectiveness and Clinical Outcomes Research Center \u2013 CECORC, Riverside University Health System Medical Center, Moreno Valley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul","family":"Coimbra","sequence":"additional","affiliation":[{"name":"Comparative Effectiveness and Clinical Outcomes Research Center \u2013 CECORC, Riverside University Health System Medical Center, Moreno Valley, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kacy","family":"Gilbert-Gard","sequence":"additional","affiliation":[{"name":"Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianne","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makenna","family":"Marty","sequence":"additional","affiliation":[{"name":"Department of Surgery, Huntington Hospital, Pasadena, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mallory","family":"Jebbia","sequence":"additional","affiliation":[{"name":"Department of Surgery, Huntington Hospital, Pasadena, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal K.","family":"Obaid-Schmid","sequence":"additional","affiliation":[{"name":"Department of Surgery, Huntington Hospital, Pasadena, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Fierro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Ley","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dunya","family":"Bayat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Scripps Memorial Hospital, San Diego, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Biffl","sequence":"additional","affiliation":[{"name":"Department of Surgery, Scripps Memorial Hospital, San Diego, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayan","family":"Ebrahimian","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areti","family":"Tillou M","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Tay-Lasso","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2479-3493","authenticated-orcid":false,"given":"Claudia","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffry","family":"Nahmias","sequence":"additional","affiliation":[{"name":"Department of Surgery, University 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