Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

Dunham, C. Michael; Sipe, Eilynn K; Peluso, LeeAnn

doi:10.1186/1471-2482-4-3

Cited by 6 publications

(4 citation statements)

References 52 publications

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“…Similarly, Butts et al [27] showed that incentive spirometry is a better predictor of pulmonary complications in patients with rib fractures than NRF or the presence of pulmonary comorbidities. A finding consistent with earlier studies which suggested that decreased spirometric volume is highly predictive of a severe torso injury [42]. Consequently, there is a growing consensus for the use of incentive spirometry to guide the prognosis and care of rib fracture patients [43].…”

Section: Discussionsupporting

confidence: 87%

Morbidity and Mortality After Rib Fracture in Elderly Patients (>65 Years Old) Compared to a Younger Cohort (≤65 Years of Age) at Doctor Hospital Renaissance Health

Mvoula¹,

Skubic²,

Weaver³

et al. 2022

Cureus

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Background: Traumatic rib fracture is a major cause of morbidity and mortality. Recent studies highlight the inadequacy of age and the number of rib fractures (NRFs) to assess patients' care needs, which may unnecessarily increase the burden of intensive care unit (ICU) admissions. Therefore, we sought to clarify the clinical outcomes of patients admitted to a level I trauma center with multiple blunt-trauma rib fractures by age and fracture location.Methods: We performed a retrospective cohort study of patients aged 18-95 admitted to Doctors Hospital at Renaissance Health with multiple rib fractures during 2017-2020. Patients with major vascular/cerebral injuries or emergency surgery from other injuries were excluded. The study population comprised 71 patients aged ≤65 and 53 patients aged >65 years. The primary study outcomes included mortality and non-home discharge. ICU length of stay (ICU-LOS), total hospital length of stay (HLOS), and days on the ventilator were the secondary outcomes. Study outcomes were also analyzed by stratifying patients by fracture location.Results: Patients aged >65 years with multiple blunt-trauma rib fractures had lower mortality rates despite a higher prevalence of comorbidities but with higher rates of non-home discharges compared to younger patients. However, the mortality and non-home discharge odds ratios were not statistically significant. Also, median ICU-LOS and HLOS were numerically higher in geriatric patients but were not statistically significant. Nonetheless, younger patients required significantly more days of respiratory support than older patients. Similar differences were observed in the clinical outcome of patients ≤65 or >65 years when stratified by fracture locations.Conclusion: Young patients with blunt trauma rib fractures may have similar, if not worse, clinical outcomes than geriatric patients. These findings underscore the need for individual assessment of the patient's trauma severity independent of age, the number of rib fractures, or fracture location to reduce ICU burden.

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Section: Discussionsupporting

confidence: 87%

Morbidity and Mortality After Rib Fracture in Elderly Patients (>65 Years Old) Compared to a Younger Cohort (≤65 Years of Age) at Doctor Hospital Renaissance Health

Mvoula¹,

Skubic²,

Weaver³

et al. 2022

Cureus

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“…In an emergency department setting, spirometry-derived inspiratory capacity was lower among patients with torso injury, although patient outcomes were not assessed. 40 …”

Section: Evidence-based Therapeutic Interventionsmentioning

confidence: 99%

Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol

Witt

Bulger

2017

Trauma Surg Acute Care Open

147

138

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Rib fractures are common among patients sustaining blunt trauma, and are markers of severe bodily and solid organ injury. They are associated with high morbidity and mortality, including multiple pulmonary complications, and can lead to chronic pain and disability. Clinical and radiographic scoring systems have been developed at several institutions to predict risk of complications. Clinical strategies to reduce morbidity have been studied, including multimodal pain management, catheter-based analgesia, pulmonary hygiene, and operative stabilization. In this article, we review risk factors for morbidity and complications, intervention strategies, and discuss experience with bundled clinical pathways for rib fractures. In addition, we introduce the multidisciplinary rib fracture management protocol used at our level I trauma center.

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“…At this cut-off point, AUC was 0.863 (p=0.037). Conclusion: Due to high NPV, BD could rule out significant abdominal injuries but can also predict need for exploratory laparotomy when less than -6.85. those with seemingly less severe trauma or have unequivocal clinical signs on initial physical examination may still have significant intra-abdominal injuries, and delayed recognition may be responsible for preventable morbidity and mortality (1).The most widely used algorithms for hemodynamically unstable patients involve diagnostic modalities such as FAST or diagnostic peritoneal lavage (DPL) to determine the need for urgent surgical intervention (5). Studies have shown that BD is a laboratory investigation that can aid in screening patients with suspected BAT alongside FAST (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…Abdominal CT is the most commonly used modality for diagnostic evaluation of patients with BAT who are hemodynamically stable. However, less than 20% of abdominal CT scans obtained in these patients are positive for intraabdominal injury and less than 3% have injuries that require surgical intervention or angiographic embolization (5). Deunk et al proposed a selective criterion in victims of blunt trauma, based on clinical, radiological, laboratory and ultrasound exam to guide use of CT scan (9).…”

Section: Introductionmentioning

confidence: 99%

Base Deficit as an Indicator of Significant Blunt Abdominal Trauma

Ojuka¹,

Nyongesa²,

Ngugi³

2018

Ann Afr Surg.

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Background: Blunt abdominal trauma (BAT) is an important cause of morbidity and mortality among trauma patients. Base deficit (BD) has been proposed as an early available tool alongside focused assessment with sonography for trauma (FAST) in the screening of patients suspected to have BAT and also to help guide the selective use of CT scan. Objective: To determine the use of BD as an indicator of significant BAT. Methods: This was an observational study carried out at the Kenyatta National Hospital from February to May 2015. Patient with suspected BAT admitted into Accident & Emergency were enrolled. Data collected included clinical assessment, BD, FAST findings, CTscan, and laparotomy were recorded. Data was analyzed using SPSS 17.0. Comparison of mean values of BD between different groups of patients (discharged

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Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

Cited by 6 publications

References 52 publications

Morbidity and Mortality After Rib Fracture in Elderly Patients (>65 Years Old) Compared to a Younger Cohort (≤65 Years of Age) at Doctor Hospital Renaissance Health

Morbidity and Mortality After Rib Fracture in Elderly Patients (>65 Years Old) Compared to a Younger Cohort (≤65 Years of Age) at Doctor Hospital Renaissance Health

Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol

Base Deficit as an Indicator of Significant Blunt Abdominal Trauma

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