Patients With Rib Fractures Do Not Develop Delayed Pneumonia: A Prospective, Multicenter Cohort Study of Minor Thoracic Injury

Émond, Marcel; Plourde, Miville; Guímont, Chantal; Sage, Natalie Le; Vanier, Laurent; Bergeron, Éric; M, Dufresne; Allain-Boulé, Nadine; Fratu, Ramona

doi:10.1016/j.annemergmed.2012.03.020

Cited by 18 publications

(19 citation statements)

References 35 publications

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“…Although this low incidence is similar to that reported in Canada (0.6%),11 our study demonstrated a high aHR of 8.94 (95% CI 3.79 to 21.09) for pneumonia in patients with IMRFs. Furthermore, old age (≥65 years; aHR=5.60 (95% CI 1.97 to 15.89)) and COPD (aHR=5.41, 95% CI 1.02 to 3.59) were risk factors for pneumonia after IMRFs.…”

Section: Discussionsupporting

confidence: 82%

“…Furthermore, patients with a history of pneumonia before chest traumas were excluded. IMRFs are defined as single or two rib fractures (ICD-9-CM 807.01 and 807.02) without other associated injuries 11. In addition, data on diagnostic tests, such as chest X-ray (XR; order codes: 32001C, 32002C and 32003C) and CT; order codes: 33066B, 33070B, 33071B, and 33072B), were also obtained.…”

Section: Methodsmentioning

confidence: 99%

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Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study

Teng

Yang

et al. 2017

BMJ Open

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ObjectivesIsolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas.DesignNationwide population-based cohort study.SettingPatients with IMRFs were identified between 2010 and 2011 from the Taiwan National Health Insurance Research Database.ParticipantsNon-traumatic patients were matched through 1:8 propensity-score matching according to age, sex, and comorbidities (namely diabetes, hypertension, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD)) with the comparison cohort. We estimated the adjusted HRs (aHRs) by using the Cox proportional hazard model. A total of 709 patients with IMRFs and 5672 non-traumatic patients were included.Main outcome measureThe primary end point was the occurrence of pneumonia within 30 days.ResultsThe incidence of pneumonia following IMRFs was 1.6% (11/709). The aHR for the risk of pneumonia after IMRFs was 8.94 (95% CI=3.79 to 21.09, p<0.001). Furthermore, old age (≥65 years; aHR=5.60, 95% CI 1.97 to 15.89, p<0.001) and COPD (aHR=5.41, 95% CI 1.02 to 3.59, p<0.001) were risk factors for pneumonia following IMRFs. In the IMRF group, presence of single or two isolated rib fractures was associated with an increased risk of pneumonia with aHRs of 3.97 (95% CI 1.09 to 14.44, p<0.001) and 17.13 (95% CI 6.66 to 44.04, p<0.001), respectively.ConclusionsAlthough the incidence of pneumonia following IMRFs is low, patients with two isolated rib fractures were particularly susceptible to pneumonia. Physicians should focus on this complication, particularly in elderly patients and those with COPD.

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Section: Discussionsupporting

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study

Teng

Yang

et al. 2017

BMJ Open

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“…Of the articles outlined in Table 1 , 2 were prospective, single-center, cohort studies 12 , 13 ; one was a prospective, multicenter, cohort study 14 ; and the remaining were retrospective, single-center, descriptive studies. 15 -17 In 4 of the studies, the evaluations were obtained during a single posthospitalization assessment, 50 days to 12 years after injury, 12 , 15 -17 whereas the remaining 2 studies evaluated patients through a series of 4 assessments in the days to months after injury.…”

Section: Methodsmentioning

confidence: 99%

“…13 , 14 In 5 studies, the sample sizes were small, ranging from 20 to 46 persons; of those, 4 studies had issues with patient retention, leaving a range of 14 to 32 total patients available for interpretation. 12 , 13 , 15 -17 Chauny et al 14 included several centers, which yielded 1057 subjects in that study. …”

Section: Methodsmentioning

confidence: 99%

Long-term Outcomes After Blunt Injury to the Boney Thorax

Senn-Reeves

Staffileno

2013

Journal of Trauma Nursing

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Management of blunt injury to the boney thorax centers on the hospital; yet, these injuries continue to impact patients long after hospitalization. The purpose of this literature review was to identify long-term outcomes associated with this injury. A literature search found 616 studies and, after screening, yielded 6 articles for review. Patient and injury characteristics and postinjury assessment findings were explored. The impact of this injury can be prolonged and life altering, prompting the need for further investigation. A greater understanding of injury-specific posthospitalization outcomes could elucidate the impact of these injuries on patients, families, and society.

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“…Probably some therapeutic procedures and further diagnostic workup were not documented in the charts. For example respiratory care exercises/physiotherapy to avoid pneumonias are a common supportive therapy [18], but on the other hand the risk of developing these complication seems to be low [22]. 70 of the 157 patients with proven fractures in the RS did not receive an additional CR.…”

Section: Abb 1 64-jähriger Patient Mit Frakturen Der Rippen Vu-ix (☆mentioning

confidence: 99%

Clinical Significance of Conventional Rib Series in Patients with Minor Thoracic Trauma

Hoffstetter

Dornia

Wagner

et al. 2014

Fortschr Röntgenstr

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Hintergrund: Hemithoraxaufnahmen (HT) sind eine spezielle radiografische Technik zur Darstellung der knöchernen Anteile der Thoraxwand. Die Technik findet häufig Anwendung in der Evaluation von Bagatelltraumen des Thorax, oft in Kombination mit Thoraxübersichtsaufnah-men (THÜ Background: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. Methods: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. Results: We included 669 patients (61.4 % men, 38.6 % women, median age: 51 years, range: 13 -92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5 %) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5 %) patients. Considering the 157 patients with fractured ribs, 73 (46.8 %) had a single fracture, 38 (24.4 %) and two fractures and 45 (28.8 %) had more than two fractures. When assessing the 405 CRs, we detected 69 (17 %) fractures while the corresponding RS of the same patients revealed 87 (21.5 %) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1 % received medical therapy, while 64.5 % of those patients without a radiologically documented fracture also received therapy (p = 0.25). Conclusion: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Patients With Rib Fractures Do Not Develop Delayed Pneumonia: A Prospective, Multicenter Cohort Study of Minor Thoracic Injury

Cited by 18 publications

References 35 publications

Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study

Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study

Long-term Outcomes After Blunt Injury to the Boney Thorax

Clinical Significance of Conventional Rib Series in Patients with Minor Thoracic Trauma

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