Chest Trauma Scoring Systems for Predicting Respiratory Complications in Isolated Rib Fracture

Seok, Junepill; Cho, Hyun Min; Kim, Ho; Kim, Jae‐Hun; Song, Seunghwan; Kim, Hyung Bin; Leem, Jae Hwang; Wang, Il Jae

doi:10.1016/j.jss.2019.06.009

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…Significant effort has been devoted to developing prediction algorithms and risk scores to identify patients at high risk of pulmonary complications. 8,9,20,[27][28][29][30] However, many of these algorithms rely only on patient characteristics at the time of admission, retrospectively look at the entire hospital course (not just the time of floor transfer), use defined pulmonary complications as an outcome (as opposed to respiratory events), have not been extensively validated in other cohorts, and have been limited to patients with chest wall injury. The applicability and utility of these scoring systems at the time of ward transfer is not currently established.…”

Section: Discussionmentioning

confidence: 99%

“…Existing work on respiratory complications following injury has typically focused on characterizing them either in the ICU, 7,[12][13][14][15] in specific patient subgroups, [16][17][18] or predicting their occurrence across an entire hospitalization at the time of admission. 8,[19][20][21][22] As a result, it is difficult to identify times and locations for targeted interventions. Furthermore, prior work solely using clinical registry data is limited to complications adjudicated by abstractors, which may miss clinically relevant events.…”

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confidence: 99%

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Respiratory events after intensive care unit discharge in trauma patients: Epidemiology, outcomes, and risk factors

Rosen¹,

Bulger²,

Cuschieri³

2021

J Trauma Acute Care Surg

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BACKGROUND:Respiratory complications are associated with significant morbidity and mortality in trauma patients. The care transition from the intensive care unit (ICU) to the acute care ward is a vulnerable time for injured patients. There is a lack of knowledge about the epidemiology of respiratory events and their outcomes during this transition. METHODS:Retrospective cohort study in a single Level I trauma center of injured patients 18 years and older initially admitted to the ICU from 2015 to 2019 who survived initial transfer to the acute care ward. The primary outcome was occurrence of a respiratory event, defined as escalation in oxygen therapy beyond nasal cannula or facemask for three or more consecutive hours. Secondary outcomes included unplanned intubation for a primary pulmonary cause, adjudicated via manual chart review, as well as in-hospital mortality and length of stay. Multivariable logistic regression was used to examine patient characteristics associated with posttransfer respiratory events. RESULTS:There were 6,561 patients that met the inclusion criteria with a mean age of 52.3 years and median Injury Severity Score of 18 (interquartile range, 13-26). Two hundred and sixty-two patients (4.0%) experienced a respiratory event. Respiratory events occurred early after transfer (median, 2 days, interquartile range, 1-5 days), and were associated with high mortality (16% vs. 1.8%, p < 0.001), and ICU readmission rates (52.6% vs. 4.7%, p < 0.001). Increasing age, male sex, severe chest injury, and comorbidities, including preexisting alcohol use disorder, congestive heart failure, and chronic obstructive pulmonary disease, were associated with increased odds of a respiratory event. Fifty-eight patients experienced an unplanned intubation for a primary pulmonary cause, which was associated with an in-hospital mortality of 39.7%. CONCLUSION:Respiratory events after transfer to the acute care ward occur close to the time of transfer and are associated with high mortality. Interventions targeted at this critical time are warranted to improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Respiratory events after intensive care unit discharge in trauma patients: Epidemiology, outcomes, and risk factors

Rosen¹,

Bulger²,

Cuschieri³

2021

J Trauma Acute Care Surg

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“…Despite this, our results are similar to those found previously. 11,20,21 Finally, the lack of predictive ability of OIS and AIS appears to be incongruous with the generally positive correlation with the increasing score for complications and mortality. This can be explained as artifactual, as a paucity of patients sustaining severe (score 4) injuries where small absolute changes yield large percent changes.…”

Section: Discussionmentioning

confidence: 99%

“…To date, only 3 small studies have included analyses of either of these chest scores and have found disappointing correlations with their limited data sets. 11,20,21 It is unknown if either scoring scale correlates with clinical endpoints of one of the most commonly encountered injuries. We hypothesized that OIS and AIS scoring systems are not associated with rib or sternal facture outcomes.…”

Section: Introductionmentioning

confidence: 99%

Does chest wall Organ Injury Scale (OIS) or Abbreviated Injury Scale (AIS) predict outcomes? An analysis of 16,000 consecutive rib fractures

Baker

Millar

Heh

et al. 2020

Surgery

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“…Although there are several scoring systems for pulmonary contusion and trauma, there is no scoring system used in clinical routine. [7,8] Therefore, we did not make a detailed evaluation of pulmonary contusion. Pulmonary function tests and quality of life questionnaire (Short Form-36 [SD-36]) were performed in the sixth postoperative month and the results were evaluated.…”

Section: Methodsmentioning

confidence: 99%

The benefits of early rib fixation for clinical outcomes of flail chest patients in intensive care unit

Ağababaoğlu

Ersöz

2020

Turk Gogus Kalp Dama

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Bu çalışmada yelken göğüs hastalarında konservatif ve cerrahi stabilizasyon yaklaşımlarının klinik sonuçları karşılaştırıldı ve erken redüksiyonun etkisi araştırıldı. Ça lış m a pla nı: Mart 2013-Aralık 2017 tarihleri arasında erken kaburga fiksasyonu yapılan yelken göğüslü 34 hasta (23 erkek, 11 kadın; ort. yaş 43.7±12.1 yıl; dağılım 20-74 yıl) cerrahi grubuna ve Şubat 2012-Aralık 2017 tarihleri arasında konservatif yaklaşım ile takip edilen yelken göğüslü 29 hasta (19 erkek, 10 kadın; ort. yaş 45.7±15.8 yıl; dağılım 24-74 yıl) konservatif tedavi grubuna alındı. Travmanın olduğu gün veya bir sonraki gün (24 ila 36 saat içerisinde) erken kaburga redüksiyonu uygulandı. Hastanede kalış süresi, ameliyat sonrası dönemde pnömoni ve septik komplikasyon varlığı, mortalite, mekanik ventilasyon süresi, trakeostomi oranı, solunum fonksiyon test sonuçları ve ağrı skorları kaydedildi ve gruplar arasında karşılaştırıldı. Bul gu lar: Hastanede ve yoğun bakım ünitesinde yatış süresi ve mekanik ventilasyon süresi cerrahi grubuna kıyasla, konservatif tedavi grubunda istatistiksel olarak anlamlı düzeyde daha uzun idi (sırasıyla p<0.001, p<0.001 ve p<0.001). Cerrahi grupta hiçbir hastada trakeostomi gerekmez iken, konservatif tedavi grubunda beş hastada trakeostomi gereksinimi oldu (p= 0.004). Mortalite oranları cerrahi ve konservatif tedavi gruplarında sırasıyla %2.94 ve %20.69 idi (p= 0.027). Ağrı skorları, konservatif tedavi grubuna kıyasla, cerrahi grup lehine istatistiksel olarak anlamlı düzeyde farklı idi (sırasıyla p= 0.0038 ve p= 0.044). So nuç:Çalışmamızın sonuçları erken fiksasyon ve erken ekstübasyonun mekanik ventilasyon gereksinimini, hastanede yatış süresini, trakeostomi ihtiyacını ve ölüm oranlarını azalttığını göstermektedir. Bu yaklaşım, yelken göğüs hastalarında uzun dönem ağrı şikayetinde ve solunum fonksiyon testlerinde önemli bir iyileşme sağlar. Anah tarsöz cük ler: Yelken göğüs, kilitli kaburga plağı, kaburga kırığı, toraks travması.

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Chest Trauma Scoring Systems for Predicting Respiratory Complications in Isolated Rib Fracture

Cited by 20 publications

References 23 publications

Respiratory events after intensive care unit discharge in trauma patients: Epidemiology, outcomes, and risk factors

Respiratory events after intensive care unit discharge in trauma patients: Epidemiology, outcomes, and risk factors

Does chest wall Organ Injury Scale (OIS) or Abbreviated Injury Scale (AIS) predict outcomes? An analysis of 16,000 consecutive rib fractures

The benefits of early rib fixation for clinical outcomes of flail chest patients in intensive care unit

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