Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study

Émond, Marcel; Guímont, Chantal; Daoust, Raoul; Bergeron, Éric; Vanier, Laurent; Moore, Lynne; Plourde, Miville; Kuimi, Batomen; Boucher, Victor J.; Allain-Boulé, Nadine; Sage, Natalie Le

doi:10.9778/cmajo.20160096

Cited by 13 publications

(16 citation statements)

References 40 publications

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“…The initial cohort for the main study included a total of 1,474 patients. 6 Of those, patients without a confirmed rib fracture (997), patients on warfarin (11), and patients lost to follow-up (27) were excluded, leaving a sample of 439 patients. Incentive spirometry was prescribed to 41.5% of these patients at ED discharge.…”

Section: Resultsmentioning

confidence: 99%

“…This is a planned sub-analysis of a multicentre prospective cohort study. 6 Patients were included if they 1) were ≥16 years old; 2) presented to a participating ED with at least one confirmed rib fracture on radiographs between 2006 and 2012; and 3) were discharged from the ED. An incentive spirometry prescription was left to the discretion of the attending physician.…”

Section: Settingmentioning

confidence: 99%

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Potential benefits of incentive spirometry following a rib fracture: a propensity score analysis

Batomen

Laguë

Boucher

et al. 2019

CJEM

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ObjectivesIncentive Spirometry is commonly used for respiratory recovery. The literature on incentive spirometry and its impact on patients with rib fracture is unclear and there are no recommendations regarding its use in the Emergency Department (ED), particularly in rib fracture patients, which are known for increasing the risk of pulmonary complication. Therefore, the objective of this study was to assess the use of incentive spirometry and to measure its impacts on delayed complications in patients discharged from the ED with confirmed rib fracture.MethodsThis is a planned sub-study of a prospective observational cohort recruited in 4 Canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with at least one confirmed rib fracture on radiographs were included. Prescription of incentive spirometry was left to attending physician. Main outcomes were development of pneumonia, atelectasis, and hemothorax within 14 days. Propensity score matching analyses were performed.Results439 patients were included and 182 (41.5%) patients received incentive spirometry. There were 99 cases of hemothorax (22.6%), 103 cases of atelectasis (23.5%) and 4 cases of pneumonia (0.9%). The use of incentive spirometry was not protector for hemothorax [RR = 1.03 (0.66–1.64)] and atelectasis or pneumonia [RR = 1.07 (0.68–1.72)].ConclusionsOur results suggest that unsupervised incentive spirometry use does not have a protective effect against delayed pulmonary complications after rib fracture. Further research should be conducted to assess the usefulness of incentive spirometry in specific injured population in the ED.

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Section: Resultsmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

Potential benefits of incentive spirometry following a rib fracture: a propensity score analysis

Batomen

Laguë

Boucher

et al. 2019

CJEM

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“…This is a secondary analysis of a prospective multicenter observational cohort study that took place between November 2006 and May 2012 in four Canadian university a liated emergency departments (ED),two of which were level I trauma centers, one level II trauma center and one academic non-trauma center (16).…”

Section: Settingmentioning

confidence: 99%

“…The association between cough capacity and atelectasis was a secondary analysis from a cohort study designed to build a clinical decision rule for delayed hemothorax after mTI (16). In addition, the measurement of atelectasis and coughing ability were done simultaneously, which may limit the interpretation of the association observed in this study.…”

Section: Limit and Strengthmentioning

confidence: 99%

Does reduced cough capacity in minor thoracic injury is associated with atelectasis development?

Hegg

Batomen

Thériault

et al. 2021

Preprint

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Context: Minor thoracic injury causes non-negligible pain that could reduce the cough capacity and can cause infectious problems and atelectasis. Objectives: To describe the association between atelectasis and cough capacity, and to assess the concordance of cough capacity perceptions between health professionals and the patient. Design:The data were collected from 2006 to 2012 in 4 Canadian emergency departments (ED). Participants: Patients with a chief complaint of minor thoracic injury, ≥ 16 years old, discharged home from the ED after an evaluation by the attending physician, were included. They have three visits, at the ED, 7-day and 14-day follow-up. The initial ED visit included medical evaluation, data collection and mandatory chest and rib radiography. Main outcome measures: The presence of atelectasis was noted at the initial ED and subsequent visits.Participants cough capacity was noted by a physician, a nurse and the patients himself at subsequentvisits and classified as good, diminished, weak /absent.Results: Among the 1474 patients, 8.89% (95% CI: 7.55 - 10.47), 7.33% (95% CI: 6.04 – 8.89) and 4.63% (95% CI: 3.51 – 6.09) had atelectasis at the initial visit, 7-day and 14-day follow-up visit respectively. Except for patients with weak or absent cough capacity at the 7-day visit, which had a 2.89 (95%CI: 2.05 – 4.05) folds atelectasis proportion relative to those with a good cough capacity, they were no associations between cough capacity and atelectasis. The weighted kappa coefficient suggests a moderate to substantial agreement between the cough capacity measured by patients and nurses (0.52 to 0.65).Conclusion: There was not strong evidence of an association between atelectasis and cough capacity and the best agreement between cough capacity perception was between nurses and patients.

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“…However, in the delayed case, especially for closed traumatic condition, the current imaging techniques cannot readily capture the initial bleeding within pleural cavity. It is because hemothorax may not occur until hours or even days after injury, and these examinations are often carried out till patients manifest noticeable symptoms [15,16], including chest pain and difficulty in breathing [14,17]. If treated too late, delayed massive hemothorax could be life-threatening [13,18].…”

Section: Introductionmentioning

confidence: 99%

Real-Time Detection of Hemothorax and Monitoring its Progression in a Piglet Model by Electrical Impedance Tomography: A Feasibility Study

Yang

Zhang

Liu

et al. 2020

BioMed Research International

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Hemothorax is a serious medical condition that can be life-threatening if left untreated. Early diagnosis and timely treatment are of great importance to produce favorable outcome. Although currently available diagnostic techniques, e.g., chest radiography, ultrasonography, and CT, can accurately detect hemothorax, delayed hemothorax cannot be identified early because these examinations are often performed on patients until noticeable symptoms manifest. Therefore, for early detection of delayed hemothorax, real-time monitoring by means of a portable and noninvasive imaging technique is needed. In this study, we employed electrical impedance tomography (EIT) to detect the onset of hemothorax in real time on eight piglet hemothorax models. The models were established by injection of 60 ml fresh autologous blood into the pleural cavity, and the subsequent development of hemothorax was monitored continuously. The results showed that EIT was able to sensitively detect hemothorax as small as 10 ml in volume, as well as its location. Also, the development of hemothorax over a range of 10 ml up to 60 ml was well monitored in real time, with a favorable linear relationship between the impedance change in EIT images and the volume of blood injected. These findings demonstrated that EIT has a unique potential for early diagnosis and continuous monitoring of hemothorax in clinical practice, providing medical staff valuable information for prompt identification and treatment of delayed hemothorax.

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Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study

Cited by 13 publications

References 40 publications

Potential benefits of incentive spirometry following a rib fracture: a propensity score analysis

Potential benefits of incentive spirometry following a rib fracture: a propensity score analysis

Does reduced cough capacity in minor thoracic injury is associated with atelectasis development?

Real-Time Detection of Hemothorax and Monitoring its Progression in a Piglet Model by Electrical Impedance Tomography: A Feasibility Study

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