Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank

Abstract

BackgroundIn recent years, there has been increasing interest in the treatment of patients with rib fractures. However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent. Furthermore, although it has been suggested that there is a large heterogeneity among patients with traumatic rib fractures, there is insufficient literature reporting on the outcomes of different subgroups.MethodsA retrospective cohort study using the National Trauma Data Bank was performed. All adult patients with one or more traumatic rib fractures or flail chest who were admitted to a hospital between January 2010 and December 2016 were identified by the International Classification of Diseases Ninth Revision diagnostic codes.ResultsOf the 564 798 included patients with one or more rib fractures, 44.9% (n=2 53 564) were patients with polytrauma. Two per cent had open rib fractures (n=11 433, 2.0%) and flail chest was found in 4% (n=23 388, 4.1%) of all cases. Motor vehicle accidents (n=237 995, 51.6%) were the most common cause of rib fractures in patients with polytrauma and flail chest. Blunt chest injury accounted for 95.5% (n=5 39 422) of rib fractures. Rib fractures in elderly patients were predominantly caused by high and low energy falls (n=67 675, 51.9%). Ultimately, 49.5% (n=2 79 615) of all patients were admitted to an intensive care unit, of whom a quarter (n=146 191, 25.9%) required invasive mechanical ventilatory support. The overall mortality rate was 5.6% (n=31 524).DiscussionTraumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. Worse outcomes were predominantly observed among patients with polytrauma and flail chest. Future studies should recognize these differences and treatment should be evaluated accordingly.Level of evidenceII/III.

Trends in incidence rate, health care use, and costs due to rib fractures in the Netherlands

“…The mean HLOS increased with severity of the injury (single or multiple rib fractures, or a flail chest), but without data on concomitant injuries, need for additional interventions (e.g., chest tube, surgical stabilization of rib fractures (SSRF), or video-assisted thoracoscopic surgery (VATS), or complications such as pneumonia, the true impact on the HLOS attributable to sustaining rib fractures, is not known. Nonetheless, it has been shown that almost half of the patients with rib fractures are polytraumatized (i.e., ISS > 15) patients and require Intensive Care Unit admission, demonstrating that rib fractures are a marker of severe injury [35]. admitted (b, e, and h) and admitted (c, f, and i…”

Automatic detection of rib fractures: Are we there yet?

“…Rib fractures are clinically relevant injuries associated with significant pulmonary morbidity and mortality, requiring prompt evaluation and management. The study of a large retrospective cohort study by Peek et al confirmed that traumatic rib fractures must be considered as a surrogate marker of severe injury leading to worse patient outcomes [1] . In this study, the highest mortality rate was observed among patients with flail chest (13.0%).…”

“…Traumatic rib fractures represent the most common injury sustained following thoracic trauma [1] . Rib fractures are clinically relevant injuries associated with significant pulmonary morbidity and mortality, requiring prompt evaluation and management.…”

Retrospective study on rib fractures: smoking and alcohol matter for mortality and complications

“…1 These injuries are associated with variable rates of mortality (4% to 25%) and pulmonary complications (13% to 35%). [1][2][3][4][5] Many studies have identified risk factors and developed scores and protocols to predict and improve outcomes for these patients because of the potential benefit of accurate risk stratification, given the high frequency and severity of these injuries. [6][7][8][9][10][11][12][13] Although variables such as age, number of ribs fractured, and comorbidities have been identified as risk factors, [14][15][16][17][18][19] smoking and alcohol use disorder (AUD) have not been studied as thoroughly.…”

“…23 24 Many of these studies use data from national or urban populations with limited generalizability; our state has unique characteristics compared with the rest of the USA, including a higher percentage of smokers (23% vs 14%). 25 26 Certain subgroups of patients with rib fractures have variable outcomes, 2 so data from specific populations may be helpful in understanding the associations between smoking and AUD and outcomes.…”