Multiple rib fractures: does flail chest matter?

Daskal, Yaakov; Paran, Maya; Korin, Alexander; Soukhovolsky, V. G.; Kessel, Boris

doi:10.1136/emermed-2020-210999

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…In contrast to our study results, other studies have already indicated respiratory failure as being more likely associated with the underlying lung injury rather than chest wall motion mechanics 15 , 30 – 32 , since Trinkle et al’s study 50 years ago 33 . In this prospective study conducted with 30 patients with flail chest, the authors concluded that the role of flail motion was minor.…”

Section: Discussioncontrasting

confidence: 99%

“…Respiratory failure by muscle fatigue can even occur several days after the initial trauma 11 – 14 . Several recent studies have also concluded that the presence of the flail chest does not affect adverse outcomes 15 , 32 . However, these two studies were conducted without distinction between the anatomic flail segment and the paradoxical chest wall movement.…”

Section: Discussionmentioning

confidence: 99%

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Novel nomogram for predicting pulmonary complications in patients with blunt chest trauma with rib fractures: a retrospective cohort study

Seok

Yoon

Lee

et al. 2023

Sci Rep

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The direct consequences of chest trauma may cause adverse outcomes. Therefore, the early detection of high-risk patients and appropriate interventions can improve patient outcomes. This study aimed to investigate the risk factor for overall pulmonary complications in patients with blunt traumatic rib fractures. Prospectively recorded data of patients with blunt chest trauma in a level 1 trauma center between January 2019 and October 2022 were retrospectively analyzed. The primary outcomes were one or more pulmonary complications. To minimize the overfitting of the prediction model, we used the least absolute shrinkage and selection operator (LASSO) logistic regression. We input selected features using LASSO regression into the multivariable logistic regression model (MLR). We also constructed a nomogram to calculate approximate individual probability. Altogether, 542 patients were included. The LASSO regression model identified age, injury severity score (ISS), and flail motion of the chest wall as significant risk factors. In the MLR analysis, age (adjusted OR [aOR] 1.06; 95% confidence interval [CI] 1.03–1.08; p < 0.001), ISS (aOR 1.10; 95% CI 1.05–1.16; p < 0.001), and flail motion (aOR 8.82; 95% CI 4.13–18.83; p < 0.001) were significant. An MLR-based nomogram predicted the individual risk, and the area under the receiver operating characteristic curve was 0.826. We suggest a novel nomogram with good performance for predicting adverse pulmonary outcomes. The flail motion of the chest wall may be the most significant risk factor for pulmonary complications.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Novel nomogram for predicting pulmonary complications in patients with blunt chest trauma with rib fractures: a retrospective cohort study

Seok

Yoon

Lee

et al. 2023

Sci Rep

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“…Accordingly, recent nationwide studies by Peek et al [29] and Kishawi et al [30] reported mortality rates of 2.1-2.5% among patients with isolated rib fractures with HLOS, LOS, and DOV similar to those observed in our study [29]. Furthermore, newer studies are indicating that NRF is not associated with worst mortality, HLOS, ICU-LOS, or days on mechanical ventilation [31][32], unlike those of Bulger et al [3], Stawicki et al [25], and Pape et al [26]. Their studies all noted a positive association between NRF and mortality.…”

Section: Discussionsupporting

confidence: 86%

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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“…Despite their efficacy, these methods may result in substantial muscle disruption and subsequent permanent disability of the affected limb. 31 In this research, we conducted the comparative analysis of the outcomes linked to two types of rib fracture fixation techniques: EF utilizing a thoracic girdle and internal fixation utilizing the auscultatory triangle method. Various factors were evaluated, such as the overall patient prognosis, secondary trauma and postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional surgical techniques, including longitudinal, posterior or anterior incisions, have been the norm. Despite their efficacy, these methods may result in substantial muscle disruption and subsequent permanent disability of the affected limb 31 …”

Section: Discussionmentioning

confidence: 99%

Comparative study of wound outcomes and surgical strategies: Internal fixation versus external stabilization in rib fracture patients with traumatic chest wounds

Wang,

Wang

et al. 2023

International Wound Journal

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The clinical management of traumatic chest incisions accompanied by rib fractures presents the formidable challenge. The study was carried out to compare the outcomes of auscultatory triangle internal fixation (ATIF) and external fixation (EF) in such injuries. From June 2019 to June 2022, 105 patients with multiple rib fractures participated in the cohort study in which they were divided into two groups: 53 patients underwent ATIF and 52 patients underwent EF. The incidence of surgical site infection, wound healing time, incidence of wound dehiscence, number of dressing changes, pain as measured by the visual analogue scale (VAS), duration of hospitalization, period of return to work, pulmonary complications and functionality of the upper limbs as assessed by the Disability of Arm, Shoulder, and Hand (DASH) questionnaire were among the parameters evaluated. In comparison with EF, ATIF demonstrated the decreased incidence of wound dehiscence (1.9% vs. 9.6%) (p < 0.05), surgical site infection (3.8 vs. 11.5) and wound healing time (12.3 ± 2.1 vs. 18.5 ± 3.7 days) (p < 0.05). Furthermore, during their ATIF treatment, patients required fewer changes of dressing (3.5 ± 0.8 vs. 5.7 ± 1.2) and demonstrated enhanced pain management, reduced hospital stays and expedited return to work (p < 0.05). ATIF group demonstrated enhancements in both upper limb functionality and post‐operative pulmonary function (p < 0.05). The utilization of ATIF as opposed to EF for the treatment of traumatic chest wounds accompanied by rib fractures yields superior outcomes in terms of wound healing, infection reduction and restoration of pulmonary and upper limb functionality.

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Multiple rib fractures: does flail chest matter?

Cited by 9 publications

References 16 publications

Novel nomogram for predicting pulmonary complications in patients with blunt chest trauma with rib fractures: a retrospective cohort study

Novel nomogram for predicting pulmonary complications in patients with blunt chest trauma with rib fractures: a retrospective cohort study

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

Comparative study of wound outcomes and surgical strategies: Internal fixation versus external stabilization in rib fracture patients with traumatic chest wounds

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