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

Abstract

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.

Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study

“…The development of a haemothorax can be attributed to diaphragmatic injury, compromised intercostal vessels, or fracture disruption resulting in lung parenchymal involvement . Likewise following trauma, a pneumothorax commonly manifests secondary to a laceration of the visceral pleura following rib fracture dislocation . An increased incidence of morbidity and mortality associated with these pulmonary sequelae can also be relative to their treatment by way of either a tube thorocostomy or explorative thoracotomy so as to define the origin of a persistent air leak or a compromised blood vessel …”

Decision tree for ward admissions of older patients at the emergency department after a fall

“…The chances of being admitted to a ward were also high (71.4%) for patients with fractures involving the vertebrae, pelvis, long bones of the lower or upper limbs, or in the case of multiple rib fractures. This might reflect the relevant burden of such injuries due to the need for surgery, or for a controlled environment because of the patient's impaired mobility, potential complications or difficult pain control . It is worth noting how the probability of hospitalization for this last category of patients further increased if they were taking anticoagulants.…”

“…This might reflect the relevant burden of such injuries due to the need for surgery, or for a controlled environment because of the patient's impaired mobility, potential complications or difficult pain control. 8,[10][11][12] It is worth noting how the probability of hospitalization for this last category of patients further increased if they were taking anticoagulants. As for the presence of internal bleeding, the risk of hemorrhage related to the use of anticoagulants thus seems to orient the decision towards admission to a ward, although whether falls in older patients taking anticoagulants are associated with a higher risk of bleeding is still a matter of debate.…”

“…For fractures, we collected information on the site and number of reported fractures, then classified them as none, one or more than one (if the fractures involved more than one bone). For the purpose of our study, we classified rib fractures as less than three versus three or more, defining the latter as “multiple rib fractures.” The site of any reported bleeding was classified in our analyses as “internal bleeding” if it involved critical areas or internal organs (e.g. intracranial, retroperitoneal, gastrointestinal or urinary hemorrhage) or “musculoskeletal bleeding” if only the musculoskeletal system was involved (e.g.…”

Manejo quirúrgico de las fracturas costales

“…El trauma de tórax corresponde al 10-20% de todos los casos de trauma (1), y en general se deben a trauma cerrado. El riesgo de morbilidad y mortalidad aumenta con el número de fracturas costales (2).…”