Does chest wall Organ Injury Scale (OIS) or Abbreviated Injury Scale (AIS) predict outcomes? An analysis of 16,000 consecutive rib fractures

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BACKGROUND:Surgical stabilization of rib fractures (SSRF) is an accepted efficacious treatment modality for patients with severe chest wall injuries. Despite increased adoption of SSRF, surgical learning curves are unknown. We hypothesized intraoperative duration could define individual SSRF learning curves. METHODS:Consecutive SSRF operations between January 2017 and December 2021 at a single institution were reviewed. Operative time, as measured from incision until skin closure, was evaluated by cumulative sum methodology using a range of acceptable "missteps" to determine the learning curves. Misstep was defined by extrapolation of accumulated operative time data. RESULTS:Eighty-three patients underwent SSRF by three surgeons during this retrospective review. Average operative times ranged from 135 minutes for two plates to 247 minutes for seven plates. Using polynomial regression of average operative times, 75 minutes for general procedural requirements plus 35 minutes per plate were derived as the anticipated operative times per procedure. Cumulative sum analyses using 5%, 10%, 15%, and 20% incident rates for not meeting expected operative times, or "missteps" were used. An institutional learning curve between 15 and 55 SSRF operations was identified assuming a 90% performance rate. An individual learning curve of 15 to 20 operations assuming a 90% performance rate was observed. After this period, operative times stabilized or decreased for surgeons A, B, and C. CONCLUSION:The institutional and individual surgeon learning curves for SSRF appears to steadily improve after 15 to 20 operations using operative time as a surrogate for performance. The implementation of SSRF programs by trauma/acute care surgeons is feasible with an attainable learning curve.

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confidence: 99%

A Method for Identifying the Learning Curve for the Surgical Stabilization of Rib Fractures

Delman

Turner

Ammann

et al. 2022

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“… 10 Current scoring systems for rib fractures are the Organ Injury Scale Chest Wall grade, Chest Trauma Score, and chest Abbreviated Injury Scale. 11 – 13 They include the number of fractures, presence of flail chest, and presence of bilateral rib fractures but do not specify rib fracture characteristics. The RibScore, which is a radiographic rib fracture scoring system based on chest computed tomography (CT), is more specific with additional components that consider fracture displacement and the anatomic area of the rib fracture location.…”

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confidence: 99%

“…The utility of such scoring systems for both internal organs and other orthopedic injuries has been described 10 . Current scoring systems for rib fractures are the Organ Injury Scale Chest Wall grade, Chest Trauma Score, and chest Abbreviated Injury Scale 11–13 . They include the number of fractures, presence of flail chest, and presence of bilateral rib fractures but do not specify rib fracture characteristics.…”

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confidence: 99%

Interobserver agreement for the Chest Wall Injury Society taxonomy of rib fractures using computed tomography images

Wijck

Curran

Sauaia

et al. 2022

BACKGROUND:In 2020, a universal nomenclature for rib fractures was proposed by the international Chest Wall Injury Society taxonomy collaboration. The purpose of this study is to validate this taxonomy. We hypothesized that there would be at least moderate agreement, regardless of the observers' background. METHODS:An international group of independent observers evaluated axial, coronal, and sagittal computed tomography images on an online platform from 11 rib fractures for location (anterior, lateral, or posterior), type (simple, wedge, or complex), and displacement (undisplaced, offset, or displaced) of rib fractures. The multirater κ and Gwet's first agreement coefficient (AC1) were calculated to estimate agreement among the observers. RESULTS:A total of 90 observers participated, with 76 complete responses (84%). Strong agreement was found for the classification of fracture location (κ = 0.83 [95% confidence interval (CI) 0.69-0.97]; AC1, 0.84 [95% CI, 0.81-0.88]), moderate for fracture type (κ = 0.46 [95% CI, 0.32-0.59]; AC1, 0.50 [95% CI, 0.45-0.55]), and fair for rib fracture displacement (κ = 0.38 [95% CI, 0.21-0.54], AC1, 0.38 [95% CI, 0.34-0.42]). CONCLUSION:Agreement on rib fracture location was strong and moderate for fracture type. Agreement on displacement was lower than expected.Evaluating strategies such as comprehensive education, additional imaging techniques, or further specification of the definitions will be needed to increase agreement on the classification of rib fracture type and displacement as defined by the Chest Wall Injury Society taxonomy.

“…Previous scoring systems [12][13][14][15][16][17] have used various criteria such as demographic, physiologic, and radiographic parameters; however, their area under the receiver operating characteristic curve (AUROC) for the development of pneumonia is approximately 0.7, which is not sufficiently predictive. 18 Therefore, a more detailed method to assess the severity of the disease is being explored. [19][20][21] Quantitative analysis of three-dimensional (3D) computed tomography (CT) images has been applied for the evaluation of respiratory function.…”

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confidence: 99%

A new quantitative assessment method for predicting pneumonia caused by chest wall injury

Kawai

Konishi

Miyazaki

et al. 2021

BACKGROUND:The severity of rib fractures has been previously evaluated by combining categorical data, but these methods have only low predictive capability for respiratory complications and mortality. This study aimed to establish a more accurate method for predicting the development of pneumonia, a frequent complication in chest injuries, using anatomical relationships. METHODS:We analyzed three-dimensional reconstructed images of 644 consecutive trauma patients who underwent whole-body computed tomography (CT) in our institution within a 36-month study period from April 2017. The anatomical relationship between the right and left thoracic volumes of non-rib fracture patients was used to estimate thoracic volume changes on the injured side in unilateral rib fracture patients. The predictive capability of changes in thoracic volume for the development of pneumonia was evaluated according to the area under the receiver operating characteristic curve and compared with that of previous chest wall severity evaluation methods. RESULTS:Of the 644 patients, 133 and 478 patients had unilateral rib fractures and non-rib fractures, respectively. The amount of change in thoracic volume due to unilateral rib fractures was significantly greater in pneumonia patients (400 mL vs. 160 mL, p < 0.01). The area under the receiver operating characteristic curve for the development of pneumonia was 0.83, which tended to be higher than that of the previous severity scoring methods. CONCLUSION:The amount of change in chest volume, which can be estimated using CT images, has better predictive capability for pneumonia than previous severity assessment methods based on categorical data. The amount of change in chest volume measured using whole-body CT can be used to rapidly determine the optimal treatment for severe chest wall injuries.