Flail chest injury—changing management and outcomes

Abstract

Purpose The purpose of this study was to assess trends in management of flail chest injuries over time and to determine impact on patient outcomes. Methods A retrospective review of data from a prospectively collated database of all trauma patients admitted to a level 1 trauma service in Victoria was conducted. All trauma patients admitted to the hospital between July 2008 and June 2020 with an Abbreviated Injury Scale (AIS) code for flail chest injury were included. Results Our study included 720 patients, mean age was 59.5 ± 17.3 years old, and 76.5% of patients were male. Length of ICU stay decreased on average by 9 h each year. Regional anaesthesia use increased by 15% per year (0% in 2009 to 36% in 2020) (p < 0.001). Surgical stabilisation of rib fractures increased by 16% per year (2.9% in 2009 to 22.3% in 2020) (p = 0.006). The use of invasive ventilation decreased by 14% per year (70% in 2008 to 27% in 2020) (p < 0.001), and invasive ventilation time decreased by 8 h per year (p = 0.007). Conclusion Over the past decade, we have seen increasing rates of regional anaesthesia and surgical rib fixation in the management of flail chest. This has resulted in lower requirements for and duration of invasive mechanical ventilation and intensive care unit stay but has not impacted mortality in this patient cohort.

Quality of life and clinical outcomes of operatively treated patients with flail chest injuries: A multicentre prospective cohort study

“…The median number of days to surgery was 2 ( 1 – 4 ) days with a mean duration of surgery of 143 ± 84 min. The median number of fixated ribs was 4 ( 3 – 5 ), which was a proportion of 0.43 of the number of fractured ribs. Video assisted thoracic surgery was performed in 6 patients (10%) aiming to better localize the fractures or identify/treat other thoracic injuries.…”

“…The median hospital length of stay was 15 ( 10 – 28 ) days. Fourtyseven (77%) patients were admitted to the ICU with a median duration of ICU stay of 8 ( 3 – 14 ) days. Mechanical ventilation was necessary in 38 patients (62%) with a median duration of 6.5 days.…”

“…Historically, patients with rib fractures were treated nonoperatively, however, since the introduction of the dedicated plating systems, rib fixation has become a routinely performed procedure in many trauma centers ( 3 ). Indications for rib fixation include flail chest injuries, failure to wean from mechanical ventilation, severe thorax deformity and inadequately manageable pain through conservative measures.…”

Is Traumatic Anterior Stove-In Chest Truly so Rare? A Single Institution Experience

“…There is currently no standard definition for stove-in chest, let alone ASIC, making it challenging to diagnose, document, research, and define best practices for management consistently across institutions. For instance, studies have referred to it as “a collapse of a segment of the chest wall” or “a type of flail chest injury where the segment collapses into the chest.” 3,4 Yet, there has been no consensus on the number of involved ribs, size of the chest wall segment, degree of collapse, or impact on respiratory mechanics needed to accurately define this injury. A collaboration from the Chest Wall Injury Society (CWIS) began the framework for standardization of chest wall injury-related injuries.…”

“…This disease state has been well-studied, and clear consensus guidelines have greatly improved its overall morbidity and mortality. 3,4 Therefore, patients with these injuries often require hospitalization and are treated based on best practices to improve outcomes.…”