Clinical efficacy of surgical versus conservative treatment for multiple rib fractures: A meta-analysis of randomized controlled trials

Long, Rui; Tian, Jun-ying; Wu, Shasha; Li, Yang; Yang, Xiuhua; Fei, Jun

doi:10.1016/j.ijsu.2020.09.010

Cited by 19 publications

(18 citation statements)

References 37 publications

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“…The rate of delayed hemopneumothorax has also been shown to be two times higher in NOM versus SSRF group 24 . Findings from individual studies have also been aggregated in a number of recent meta-analyses, which confirmed the clinical benefits of SSRF versus NOM for lung-related complications in the postoperative period 13,25 …”

Section: Discussionmentioning

confidence: 84%

“…A 2019 study by Beks et al 10 with 3.9 years follow-up included 103 patients. The recent meta-analyses do not control postoperative follow-up time, as these vary considerably from study to study, are usually short, and are often not reported 7,13,31 . Our 12-month follow-up data point thus represents an important finding that suggests sustained effectiveness of the procedure after discharge.…”

Section: Discussionmentioning

confidence: 92%

“… 24 Findings from individual studies have also been aggregated in a number of recent meta-analyses, which confirmed the clinical benefits of SSRF versus NOM for lung-related complications in the postoperative period. 13 , 25 …”

Section: Discussionmentioning

confidence: 99%

“… 10 – 12 In addition, SSRF has also been associated with reduced length of intensive care unit stay, length of hospital stay, and duration of mechanical ventilation. 13 …”

mentioning

confidence: 99%

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Outcomes of Surgical vs Non-Surgical Treatment for Multiple Rib Fractures: A US Hospital Matched Cohort Database Analysis

Shiroff

Wolf

et al. 2022

J Trauma Acute Care Surg

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“… 10 – 12 In addition, SSRF has also been associated with reduced length of intensive care unit stay, length of hospital stay, and duration of mechanical ventilation. 13 …”

mentioning

confidence: 99%

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Outcomes of Surgical vs Non-Surgical Treatment for Multiple Rib Fractures: A US Hospital Matched Cohort Database Analysis

Shiroff

Wolf

et al. 2022

J Trauma Acute Care Surg

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“…Many major trauma patients are young and were previously physically fit, making them resilient to physiological stress. This makes early extubation possible, even if return to surgery for a staged procedure is planned within 24–48 h. However, early extubation requires adequate analgesia (for which regional techniques are often particularly appropriate [ 50 ]), adequate chest wall mechanics in the case of rib fractures (suggesting possible benefit of early rib fixation in select patients [ 51 ]), and recognition that an abdominal wall with a temporary closure device (such as a Vacuum-assisted closure (VAC) dressing) does not mandate ongoing mechanical ventilation [ 52 ]. More than any other factor, the intensive care team need to overcome the natural inertia to leave a patient intubated between operations.…”

Section: Facilitate Early Extubation (9)mentioning

confidence: 99%

Perspective: the top 11 priorities to improve trauma outcomes, from system to patient level

Reade

2022

Crit Care

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Background The Haemorrhage, Airway, Breathing, Circulation, Disability, Exposure/Environmental control approach to individual patient management in trauma is well established and embedded in numerous training courses worldwide. Further improvements in trauma outcomes are likely to result from a combination of system-level interventions in prevention and quality improvement, and from a sophisticated approach to clinical innovation. Top eleven trauma priorities Based on a narrative review of remaining preventable mortality and morbidity in trauma, the top eleven priorities for those working throughout the spectrum of trauma care, from policy-makers to clinicians, should be: (1) investment in effective trauma prevention (likely to be the most cost-effective intervention); (2) prioritisation of resources, quality improvement and innovation in prehospital care (where the most preventable mortality remains); (3) building a high-performance trauma team; (4) applying evidence-based clinical interventions that stop bleeding, open & protect the airway, and optimise breathing most effectively; (5) maintaining enough circulating blood volume and ensuring adequate cardiac function; (6) recognising the role of the intensive care unit in modern damage control surgery; (7) prioritising good intensive care unit intercurrent care, especially prophylaxis for thromboembolic disease; (8) conducting a thorough tertiary survey, noting that on average the intensive care unit is where approximately 15% of injuries are detected; (9) facilitating early extubation; (10) investing in formal quantitative and qualitative quality assurance and improvement; and (11) improving clinical trial design. Conclusion Dramatic reductions in population trauma mortality and injury case fatality rate over recent decades have demonstrated the value of a comprehensive approach to trauma quality and process improvement. Continued attention to these principles, targeting areas with highest remaining preventable mortality while also prioritising functional outcomes, should remain the focus of both clinician and policy-makers.

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Thoraxtrauma, Polytrauma

Larsen¹,

Mathes²

2021

Pocket Guide Beatmung

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Clinical efficacy of surgical versus conservative treatment for multiple rib fractures: A meta-analysis of randomized controlled trials

Cited by 19 publications

References 37 publications

Outcomes of Surgical vs Non-Surgical Treatment for Multiple Rib Fractures: A US Hospital Matched Cohort Database Analysis

Outcomes of Surgical vs Non-Surgical Treatment for Multiple Rib Fractures: A US Hospital Matched Cohort Database Analysis

Perspective: the top 11 priorities to improve trauma outcomes, from system to patient level

Thoraxtrauma, Polytrauma

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