Effect of seat belt legislation on the incidence of sternal fractures seen in the accident department.

17 Zimmern RL, Campbell FW, Wilkinson IMS. Subtle disturbances of vision after optic neuritis elicited by studying contrast sensitivity. Effect of seat belt legislation on the incidence of sternal fractures seen in the accident department In the United Kingdom legislation on the compulsory wearing of seat belts was introduced on 1 February 1983. Subsequently the number of front seat occupants of vehicles wearing seat belts increased dramatically. There is no doubt that seat belts correctly worn greatly reduce the incidence of serious and fatal injuries in automobile accidents,' 2 and in Cambridge a reduction of 20-25°/, has been seen since legislation. Seat belts may, however, be associated with certain injuries3-for example, fractured sternums-and since legislation we might expect to see an increased incidence of these.4 5 At Addenbrooke's Hospital, Cambridge, I noticed that a comparatively large proportion of front seat car occupants hurt in automobile accidents were presenting with anterior chest pain and were found to have sternal fractures. The aim of this study was therefore to determine whether the incidence of patients presenting to the casualty department with a sternal fracture had increased as a result of seat belt legislation. Method and results The data were collected from the casualty records of Addenbrooke's Hospital (which sees about 40 000 casualties a year). All patients seen in the casualty department for injuries received in automobile accidents are documented as such. is, the two years before and after legislation-all patients' sustaining injuries as front seat occupants in automobile accidents were identified. Those who received chest injuries and also those who received multiple injuries where a chest injury was not specifically recorded had their records drawn. From these it was determined which patients had sustained a sternal fracture and whether or not they had been wearing a seat belt at the time of their accident. Also included were patients brought into hospital dead as a result of an automobile accident and those admitted but who subsequently died of their injuries. From necropsy reports it was determined if any had sustained a sternal fracture (table). Comparison of the two study periods showed a highly significant increase in the number of patients presenting with sternal fractures since legislation (X2= 13d14; p<O0001). About 900, of these fractures occurred in patients claiming to have been wearing a seat belt at the time of their accident. By contrast, there was no significant change in the overall incidence …