Outcome after surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures and moderate to severe traumatic brain injury (CWIS-TBI)

Prins, Jonne T H; Lieshout, Esther M.M. Van; Ali‐Osman, Francis; Bauman, Zachary M.; Caragounis, Eva Corina; Choi, Jeff; Christie, D. Benjamin; Cole, Peter A.; DeVoe, William B.; Doben, Andrew R.; Eriksson, Evert A.; Forrester, Joseph D.; Fraser, Douglas R.; Gontarz, Brendan; Hardman, Claire; Hyatt, Daniel G.; Kaye, Adam J.; Ko, Huan Jang; Leasia, Kiara; Leon, Stuart; Marasco, Silvana; McNickle, Allison G.; Nowack, Timothy; Ogunleye, Temi D.; Priya, Prakash; Richman, Aaron; Schlanser, Victoria; Semon, Gregory; Su, Ying; Verhofstad, Michael H.J.; Whitis, Julie; Pieracci, Fredric M.; Wijffels, Mathieu M E

doi:10.1097/ta.0000000000002994

Cited by 27 publications

(33 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, literature on patients with non-flail fracture patterns shows improved short-term outcomes associated with SSRF in these patients with for example multiple severely dislocated rib fractures (40,(55)(56)(57)(58). In addition, traditional contraindications for SSRF, such as traumatic brain injury (TBI), age, or severe pulmonary contusion, are narrowing as SSRF has been shown to be a safe procedure in these patients and has even been correlated with improved outcomes in select patients (59)(60)(61).…”

Section: Ssrfmentioning

confidence: 99%

What is the optimal timing to perform surgical stabilization of rib fractures?

Prins

Wijffels²,

Pieracci

2021

J Thorac Dis

Self Cite

View full text Add to dashboard Cite

The practice of surgical stabilization of rib fractures (SSRF) for severe chest wall injury has exponentially increased over the last decade due to improved outcomes as compared to nonoperative management. However, regarding in-hospital outcomes, the ideal time from injury to SSRF remains a matter of debate. This review aims to evaluate and summarize currently available literature related to timing of SSRF. Nine studies on the effect of time to SSRF were identified. All were retrospective comparative studies with no detailed information on why patients underwent early or later SSRF. Patients underwent SSRF most often for a flail chest or ≥3 displaced rib fractures. Early SSRF (≤48-72 hours after admission) was associated with shorter hospital and intensive care unit length of stay (HLOS and ICU-LOS, respectively), duration of mechanical ventilation (DMV), and lower rates of pneumonia, and tracheostomy as well as lower hospitalization costs. No difference between early or late SSRF was demonstrated for mortality rate. As compared to nonoperative management, late SSRF (>3 days after admission), was associated with similar or worse in-hospital outcomes. The optimal time to perform SSRF in patients with severe chest wall injury is early (≤48-72 hours after admission) and associated with improved in-hospital outcomes as compared to either late salvage or nonoperative management. These data must however be cautiously interpreted due the retrospective nature of the studies and potential selection and attrition bias. Future research should focus on both factors and pathways that allow patients to undergo early SSRF.

show abstract

Section: Ssrfmentioning

confidence: 99%

What is the optimal timing to perform surgical stabilization of rib fractures?

Prins

Wijffels²,

Pieracci

2021

J Thorac Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…The findings were that there was no significant difference between the two groups in terms of the primary outcome measure of mechanical ventilation-free days; however, the group having SSRF had lower 30-day mortality and lower odds of developing pneumonia. 12 "A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures" by Pieracci et al 13 -referred to in this article as study C-was a single-center case control study, which designated people presenting with rib fractures in 2014 as the cases (all included patients underwent SSRF) and those presenting in 2013 as the controls (no SSRF) and then compared their outcomes. The findings were that people who had SSRF had a decreased likelihood of respiratory failure and tracheostomy as well as shorter duration of ventilation compared with those who did not have SSRF.…”

Section: Resultsmentioning

confidence: 99%

Emulating an RCT in observational research in chest trauma: The target trial approach

Cocco

Jennings²,

Lockwood³

2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND: While the concept of a "target trial"-optimizing the quality of observational studies by attempting to emulate the ideal world conditions of a randomized controlled trial-was first expounded over a decade ago, the take up of this concept in the design and analysis of trials in trauma is lacking. The target trial approach avoids common errors in observational research to increase its scientific validity as well as potentially enable causal questions to be answered without the expense and intricacies of a randomized controlled trial. This review article briefly introduces the reader to the concepts and utility of a "target trial" approach before providing demonstrations of its application in the subject area of chest trauma. METHODS:Four articles published in the last 5 years-two case control and two cohort studies-are chosen and considered in terms of their causal question; study population; inclusion and exclusion criteria; designation of time 0; clarity of the follow-up period; study outcomes; methods to minimize confounding; results; overall issues regarding study time; and the presence of avoidable errors such as introduction of immortal time bias or information bias. RESULTS:Two of the studies had an unclear causal question; none of the studies designated a time 0; the follow-up period was unclear for all but one of the studies; and one study had a serious issue with information bias resulting from differential misclassification. CONCLUSION: Failure to emulate a "target trial" framework may lead to serious methodologic issues in observational research. Expansion of the awareness of this approach in trauma literature will improve the quality of our observational research and potentially translate into significant benefits for our patients.

show abstract

“…This CWIS-TBI study was a multicenter, retrospective cohort study involving 19 trauma centers conducted through the Chest Wall Injury Society ( http://www.cwisociety.org ) [ 21 ]. The study was approved by each center’s local medical research ethics committee or institutional review board and informed consent was exempted.…”

Section: Methodsmentioning

confidence: 99%

“…cwiso ciety. org) [21]. The study was approved by each center's local medical research ethics committee or institutional review board and informed consent was exempted.…”

Section: Design and Participantsmentioning

confidence: 99%

“…The presence of TBI has been considered a relative contraindication for surgery, including SSRF and was often used as an exclusion criterion for rib fracture-related research [15,[18][19][20]. Recently however, the multicenter, retrospective Chest Wall Injury Society (CWIS)-TBI study reported SSRF to be safe in the presence of moderate to severe TBI (Glasgow Coma Scale [GCS] score ≤ 12) and associated with a reduced odds ratio of pneumonia and 30-day mortality [21]. This study was the first to specifically assess SSRF in the TBI population with rib fractures, but did not stratify by rib fracture pattern.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury

Prins

Lieshout

Ali‐Osman

et al. 2022

Eur J Trauma Emerg Surg

Self Cite

View full text Add to dashboard Cite

Purpose Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale ≤ 12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients. Methods A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. The primary outcome was mechanical ventilation-free days and secondary outcomes were in-hospital outcomes. In multivariable analysis, outcomes were assessed, stratified for rib fracture pattern. Results In total, 449 patients were analyzed. In patients with a non-flail fracture pattern, 25 of 228 (11.0%) underwent SSRF and in patients with a flail chest, 86 of 221 (38.9%). In multivariable analysis, ventilator-free days were similar in both treatment groups. For patients with a non-flail fracture pattern, the odds of pneumonia were significantly lower after SSRF (odds ratio 0.29; 95% CI 0.11–0.77; p = 0.013). In patients with a flail chest, the ICU LOS was significantly shorter in the SSRF group (beta, − 2.96 days; 95% CI − 5.70 to − 0.23; p = 0.034). Conclusion In patients with TBI and a non-flail fracture pattern, SSRF was associated with a reduced pneumonia risk. In patients with TBI and a flail chest, a shorter ICU LOS was observed in the SSRF group. In both groups, SSRF was safe and did not hamper neurological recovery.

show abstract

Outcome after surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures and moderate to severe traumatic brain injury (CWIS-TBI)

Cited by 27 publications

References 29 publications

What is the optimal timing to perform surgical stabilization of rib fractures?

What is the optimal timing to perform surgical stabilization of rib fractures?

Emulating an RCT in observational research in chest trauma: The target trial approach

Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury

Contact Info

Product

Resources

About