RibScore

Chapman, Brandon C.; Herbert, Benoit; Rodil, Maria; Salotto, Jennifer; Stovall, Robert T.; Biffl, Walter L.; Johnson, Jeffrey L.; Burlew, Clay Cothren; Barnett, Carlton C.; Fox, Charles J.; Moore, Ernest E.; Jurkovich, Gregory J.; Pieracci, Fredric M.

doi:10.1097/ta.0000000000000867

Cited by 131 publications

(83 citation statements)

References 24 publications

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“…At our institution, we developed the RibScore, which is a radiographic rib fracture scoring system that incorporates 6 variables seen on CT chest: (1) six or more ribs fractured, (2) bilateral rib fractures, (3) flail chest, (4) three or more severely (bicortical) displaced fractures, (5) first rib fracture, and (6) at least one fracture in each of the three anatomic areas (anterior, lateral, and posterior). The composite RibScore was significantly and linearly correlated with pneumonia, respiratory failure, and tracheostomy (16). There are several potential advantages of using chest CT that includes more detailed anatomic information regarding the fracture pattern.…”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

et al. 2016

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BackgroundChest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear.ObjectivesThe purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma.MethodsRetrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student’s t-test and chi-square analysis were used for comparison.ResultsWe identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest.ConclusionsThe chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

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Section: Discussionmentioning

confidence: 99%

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

et al. 2016

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“…We calculated RibScore and TTSS for each patient in our study. The Ribscore was the sum of six 1-point variables: (1) six or more rib fractures (2) bilateral fractures (3) flail chest (4) three or more severely displaced fractures (5) first rib fracture and (6) at least one fracture in all three anatomic areas (anterior, lateral, and posterior) [ 7 ]. According to the Ribscore, we categorized all patients into three groups: 0–1, 2–3 and 4–6.…”

Section: Methodsmentioning

confidence: 99%

“…Ribscore is a pure anatomic scoring system to predict outcomes such as pneumonia, respiratory failure, and tracheostomy. Ribscore suggests the numbers of displaced rib fracture as one of the important risk factors [ 7 ]. Thoracic trauma severity score (TTSS) was developed for prediction of outcome such as mortality and acute respiratory distress syndrome (ARDS) [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

The number of displaced rib fractures is more predictive for complications in chest trauma patients

Chien

Chen

Han

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundTraumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increase in chest complications.MethodsWe retrospectively reviewed the trauma registry between January 2013 and May 2015 in a teaching hospital in northeastern Taiwan. Patients admitted with chest trauma and rib fractures without concomitant severe brain, splenic, pelvic or liver injuries were included. The demographic data, such as gender, age, the index of coexistence disease, alcohol consumption, trauma mechanisms were analyzed as potential predictors of pulmonary complications. Pulmonary complications were defined as pneumothorax, hemothorax, flail chest, pulmonary contusion, and pneumonia.ResultsIn the 29 months of the study period, a total of 3151 trauma patients were admitted to our hospital. Among them, 174 patients were enrolled for final analysis. The most common trauma mechanism was road traffic accidents (58.6%), mainly motorbike accidents (n = 70, 40.2%). Three or more displaced rib fractures had higher specificity for predicting complications, compared to three or more total rib fractures (95.5% vs 59.1%). Adjusting the severity of chest trauma using TTSS and Ribscore by multivariable logistic regression analysis, we found that three or more rib fractures or any displaced rib fracture was the most significant predictor for developing pulmonary complication (aOR: 5.49 95% CI: 1.82–16.55). Furthermore, there were 18/57 (31.6%) patients with fewer than three ribs fractures developed pulmonary complications. In these 18 patients, only five patients had delayed onset complications and four of them had at least one displaced rib fracture.DiscussionIn this retrospective cohort study, we found that the number of displaced or total rib fractures, bilateral rib fractures, and rib fractures in more than two areas were associated with the more chest complications. Furthermore, three or more rib fracture or any displacement were found to be the most sensitive risk factor for chest complications, independent of other risk factors or severity index.ConclusionThe number of displaced rib fractures could be a strong predictor for developing pulmonary complications. For patients with fewer than three rib fractures without rib displacement and initial lung or other organ injuries, outpatient management could be safe and efficient.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-017-0368-y) contains supplementary material, which is available to authorized users.

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“…This scoring system was associated with development of pneumonia, acute respiratory failure, and tracheostomy with areas under the receiver operating characteristic curves of 0.71–0.75. 3 Patients who developed pneumonia, acute respiratory failure, or who required tracheostomy had higher summed RibScores than those who did not develop such complications. Likewise, bivariate analyses showed that each of the variables in the RibScore correlated with the same complications.…”

Section: Introductionmentioning

confidence: 94%

“…Likewise, bivariate analyses showed that each of the variables in the RibScore correlated with the same complications. 3 …”

Section: Introductionmentioning

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

134

136

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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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RibScore

Abstract: Prognostic study, level III.

Cited by 131 publications

References 24 publications

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

The number of displaced rib fractures is more predictive for complications in chest trauma patients

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

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