Blunt chest wall trauma: A review

Battle, Ceri; Hutchings, Hayley; Evans, P A

doi:10.1177/1460408613488480

Cited by 14 publications

(9 citation statements)

References 107 publications

(198 reference statements)

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“…The association between advancing age, pre-existing respiratory disease and mortality in chest wall injury is well described 7. A risk score that informs the management of the elderly patient with chest wall injury should contain a measure of preinjury morbidity or frailty and include age as a key determinant of the scoring outcome.…”

Section: Can a Risk Or Severity Score Help Guide His Management?mentioning

confidence: 99%

“…Elderly trauma patients with rib fractures have a more than twofold greater risk of mortality compared with those without (7.6% vs 20.1%, p=0.001) 6. The risk of death from rib fractures is two to five times greater in those aged 65 or older compared with those under 65 7–9. Data from the US National Trauma Data Bank show that at any age, the number of ribs fractured correlates with a significantly increased risk of pneumonia and/or death.…”

Section: Introductionmentioning

confidence: 98%

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Blunt chest trauma in the elderly: an expert practice review

et al. 2019

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Trauma in the elderly (>65 years) is an increasingly common presentation to the ED. A fall from standing height is the most common mechanism after which such patients present, and rib fracture is the most common non-spinal fracture. Thoracic injury in patients aged over 65 is associated with significant morbidity and mortality. There are currently no universally applied guidelines for assessment, investigation and management of such patients. In this expert practice review, we discuss the evidence base and options for clinical management in this vulnerable patient group.

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Section: Can a Risk Or Severity Score Help Guide His Management?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Blunt chest trauma in the elderly: an expert practice review

et al. 2019

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“…Over 11,000 patients with multiple (3) rib and/or sternal fractures are registered in the UK's Trauma Audit Research Network (TARN) database each year. 1 Over 20% of trauma presentations in the UK involve blunt chest wall trauma and the associated mortality is 22% 2 ; two-thirds of these injuries involve rib fractures. 3 The term 'multiple rib fractures' (MRFs) encompasses a wide range of injuries, from a few undisplaced, stable fractures, with little consequence, to many displaced and unstable fractures, causing chest wall disruption, respiratory failure, significant acute and chronic pain and which are associated with mechanical ventilation, lengthy critical care stays and death.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] Evidence supporting surgical stabilisation of rib fractures (SSRF) is increasing. 2 Single centre randomised controlled trials have demonstrated significant clinical benefits for patients with flail chest, [11][12][13][14] but further clinical trials are required to investigate the indications in other categories of MRF injury. 15 Inconsistent description of the clinical findings with radiology pattern of injury means there is a need to clarify taxonomy.…”

Section: Introductionmentioning

confidence: 99%

Multiple rib fractures: A novel and prognostic CT-based classification system

Simpson

Dorman

Hunt

et al. 2020

Trauma

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Background The accepted classification for multiple rib fractures is binary: flail chest or not. There is a wide spectrum of morphology with subsequent variation in the impact on chest wall mechanics and clinical outcomes. As the practice of surgical stabilisation of rib fractures evolves, there is a need for a better taxonomy. The aim of this study was to create a data-driven radiological classification system for multiple rib fractures, prognostic of both complications and surgical stabilisation of rib fracture. Methods The radiological pattern of injury was assessed for cases undergoing surgical stabilisation of rib fracture (n = 48) over a five-year period and a consecutive sample of non-operative controls (n = 48). Every rib fracture (n = 1032) was assessed on CT scans for location, displacement and comminution. An iterative classification system was developed and tested for inter-observer agreement and outcome prediction. Results The fractures occurred in a ‘series’ (≥3 consecutive ribs at a similar location) in 72% of cases: these were more likely to be displaced (p < 0.001). Variables included in the classification were the anatomical pattern (presence, length and overlap of series) and degree of displacement. The classification was prognostic for complications (p < 0.001), discriminated for fixation (C = 0.907) and had acceptable inter-observer agreement (k = 0.50). Conclusions The Sheffield Multiple Rib Fracture Classification derived categories of short/long series, and short/long flail chest, with sub-division according to the presence of displacement. It was prognostic for clinical outcomes and of surgical fixation. It may facilitate communication, comparison of outcomes and selection for management protocols.

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“…[2] Historically, analgesia and chest physiotherapy have been the primary methods of managing a patient with blunt chest wall trauma, with the main aim of reducing the acute risk of the development of potentially fatal pulmonary complications. [3] Longer-term complications have also been investigated and in a small study conducted by this research team, chronic pain was reported in 35% patients with a median pain severity score of 6 out of 10 (IQR: 3-7). [4] In a similar recent prospective study of 111 patients with isolated rib fractures, a prevalence of chronic pain of 64% and disability of 67% were reported.…”

Section: Introductionmentioning

confidence: 99%

EarLy Exercise in blunt Chest wall Trauma: a feasibility trial (ELECT Trial)

Battle

O’Neill

Toghill

et al. 2020

Preprint

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Background For patients with blunt chest wall trauma, no evidence exists regarding the optimal physiotherapy treatment aimed at addressing the longer-term complications, specifically chronic pain and disability. The overall aim of this phase of work, is to investigate whether early thoracic and shoulder girdle exercises improve chronic pain in patients with blunt chest wall trauma, when compared to normal care. Methods A single centre, parallel, feasibility randomised controlled trial was completed at a University Teaching Hospital in Wales. Adult patients with blunt chest wall trauma, admitted to hospital for greater than 24 hours, with no concurrent, immediately life-threatening injuries, were included. The intervention was a simple physiotherapy programme comprising thoracic and shoulder girdle exercises. Feasibility outcome measures included: Primary: 1) adherence to the protocol by the physiotherapy team (more than 80% of eligible patients randomised), and 2) acceptability of the intervention by the patients (less than 30% of patients dissented to participation). Secondary: 1) ability to retrieve follow up data (response rate of more than 70% of participants) and, 2) safety of the intervention compared to routine care (no more than 10% increase in serious adverse events). Results 14 patients were recruited to the trial. Clinicians randomised 100% of eligible patients during the trial period. All feasibility criteria were fully met. The intervention was safe the number of serious adverse events was comparable between the control and intervention periods. Discussion We have demonstrated that a fully powered randomised clinical trial of the ELECT Trial is feasible. Minor methodological modifications will be made for the full trial. ISRCTN Trial registration number ISRCTN 16197429

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Blunt chest wall trauma: A review

Cited by 14 publications

References 107 publications

Blunt chest trauma in the elderly: an expert practice review

Blunt chest trauma in the elderly: an expert practice review

Multiple rib fractures: A novel and prognostic CT-based classification system

EarLy Exercise in blunt Chest wall Trauma: a feasibility trial (ELECT Trial)

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