Evaluating the impact of timing to rib fixation in patients with traumatic brain injury: A nationwide analysis

Abstract

BACKGROUND Early surgical stabilization of rib fractures (SSRF) is associated with improved inpatient outcomes in patients with multiple rib fractures. However, there is still a paucity of data examining the optimal timing of SSRF in patients with concomitant traumatic brain injury (TBI). This study aimed to assess whether earlier SSRF was associated with improved outcomes in patients with multiple rib fractures and TBI. METHODS We performed a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program 2017–2020, including adult patients with TBI and multiple rib fractures who had undergone SSRF. The outcomes were post-procedural length of stay (LOS), hospital LOS, intensive care unit (ICU) LOS, in-hospital mortality, ventilator days, and tracheostomy rate. Multilevel mixed-effects regression analyses accounting for patient, injury, and hospital characteristics as well as institutional SSRF volume were used to assess the association between timing to SSRF and the outcomes of interest. As a sensitivity analysis, propensity-score matching was performed to compare patients who underwent early (<72 hours) versus late SSRF (≥72 hours). RESULTS Of 1,041 patients included in this analysis, 430 (41.3%) underwent SSRF within the first 72 hours from admission. Delay to SSRF was associated with an increase in post-procedural LOS (partial regression coefficient (β) = 0.011; p = 0.036; 95% confidence interval [CI], 0.001–0.023), longer hospital LOS (β = 0.053; p < 0.001; 95% CI, 0.042–0.064), prolonged ICU LOS (β = 0.032; p < 0.001; 95% CI, 0.025–0.038), and more ventilator days (β = 0.026, p < 0.001; 95% CI, 0.020–0.032). CONCLUSION In patients with concurrent multiple rib fractures and TBI, a delay in SSRF is associated with an increase in postprocedural LOS, hospital LOS, ICU LOS, and ventilator days. These findings suggest that the early patient selection and implementation of SSRF may play a beneficial role in patients presenting with concomitant TBI and multiple rib fractures. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

Early Repair of Rib Fractures Is Associated with Superior Length of Stay and Total Hospital Cost: A Propensity Matched Analysis of the National Inpatient Sample

“…A previous study has shown that early SSRF was associated with a shorter operating room duration [4], suggesting that patients receiving early procedures may benefit from a reduced duration of anesthesia associated with the SSRF procedure and/or reduced procedural complexity. Recent trials have demonstrated improved outcomes in patients with rib fracture as well, including decreased length of stay and ICU length stay [13]. As such, the findings of this study further reaffirm our understanding of the benefits of early rib fixation.…”

“…ISS score was also estimated using ICD-10 codes using the open-access program ICDPIC-R [10,11]. ISS was further categorized into mild (≤8), moderate (9)(10)(11)(12)(13)(14)(15), severe (16-25), and profound (≥25) [12]. The mechanism of injury was categorized as motor vehicle traffic (EXT007) or other using external cause of injury codes.…”

Emerging Value of Osseointegration for Intuitive Prosthetic Control after Transhumeral Amputations: A Systematic Review

“…24 Given the significant role of armed conflict in contemporary history, it is imperative to address the sequelae of war-related injuries through efficient, low-complication surgical strategies. 29 Amid increasing rates of amputation, there is a growing emphasis on postoperative care that extends beyond mere limb replacement with prosthetics. 30–32 In this realm, the OI method stands out as a potentially viable long-term rehabilitation strategy for individuals who have undergone upper limb amputations.…”

Eyes on the prize: harnessing computer vision for automated detection of traumatic rib and clavicle fractures in chest radiographs

“…Timely diagnosis of traumatic chest wall fractures is a crucial component to avoid delays in treatment and poor patient outcomes. 6 We commend the authors for tackling an impactful problem with the potential to improve diagnostic chest X-ray accuracy and reduce potentially avoidable radiation exposure for patients. The use of computer vision models for diagnostic radiology use cases has exploded.…”