ICU Length of Stay and Factors Associated with Longer Stay of Major Trauma Patients with Multiple Rib Fractures: A Retrospective Observational Study

Abdelwahed, Hesham S.; Martinez, F. Eduardo

doi:10.1155/2022/6547849

Cited by 4 publications

(3 citation statements)

References 39 publications

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“…Previous research has indicated strong correlations between a high Injury Severity Score (ISS) within the ‘very severe injury’ category and both prolonged ICU stays exceeding 7 days and increased mortality rates [ 25 , 26 , 27 , 28 , 29 ]. However, the findings for the SA group are contrary to this established correlation.…”

Section: Discussionmentioning

confidence: 99%

Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents

Wippel,

Lutz,

Kluckner

et al. 2024

JCM

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Background: Blunt traumatic aortic injury (BTAI) is a potentially fatal condition, typically resulting from high-velocity trauma. To date, little is known about this type of injury among skiers, who form the largest patient cohort with aortic injuries in the alpine region of Tyrol, Austria. Methods: This retrospective, single-center study at the University Hospital of Innsbruck analyzed patients who underwent endovascular treatment for blunt traumatic aortic injury from 2005 to 2023. Patient data were extracted from electronic and digitalized medical history records. Subsequent analyses compared the baseline characteristics and clinical results of the skiing accident (SA) group to the motor vehicle accident (MVA) group. Results: A total of 48 BTAI patients receiving TEVAR were included, 25 (52%) from SAs versus 23 (48%) from MVAs, who were predominantly male (92% vs. 78.3%). Despite similar preoperative risk profiles and ASA Scores (1.44 vs. 1.74) and no marked differences in BTAI injury grades or the affected aortic zones, significant disparities emerged: the SA group experienced shorter median ICU stays (3 vs. 11 days, p = 0.0007), fewer concomitant injuries (5 vs. 7, p = 0.005), and lower Injury Severity Scores (ISSs) (29 vs. 33, p = 0.003) than their MVA counterparts. The presence of rib fractures alongside other thoracic injuries, such as lung injury, pneumothorax, or hemothorax, was strongly correlated with BTAI in patients following skiing accidents (OR = 128.5). Conclusions: The injury severities and locations of BTAI in SA patients were comparable to those in MVA patients, indicating similar mechanisms of thoracic trauma. However, the SA patients experienced fewer concurrent pelvic and extremity fractures, had less post-procedural morbidity, and required shorter ICU stays. The presence of rib fractures combined with other thoracic injuries strongly suggests BTAI. These indicators should lead to prompt imaging and appropriate therapy.

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Section: Discussionmentioning

confidence: 99%

Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents

Wippel,

Lutz,

Kluckner

et al. 2024

JCM

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“…[ 9 ] Injury severity scores (ISS) were obtained from a prospectively collected trauma database with a range of 1–75 and a score >15 indicating a major traumatic injury. [ 10 ]…”

Section: Methodsmentioning

confidence: 99%

Unilateral atlanto-occipital injury

Lepard

Reed

Theiss

et al. 2022

Journal of Craniovertebral Junction and Spine

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Context Atlanto-occipital dissociation is a highly lethal ligamentous injury at the craniocervical junction (CCJ). Previous studies have described rare cases of milder forms of atlanto-occipital injury (AOI) which might be managed nonoperatively, but there is a paucity of literature on this subject. Aims: We retrospectively reviewed our institutional experience to characterize the injury patterns, treatments, and clinical courses of patients with unilateral AOI. Methods: We included patients with radiographic evidence of unilateral occipitocervical joint capsular disruption, distraction, or edema ± injury of the apical ligament, tectorial membrane, anterior atlanto-occipital membrane, posterior atlanto-occipital membrane, alar ligaments, or cruciate ligament. The long-term outcomes were gathered from medical records, and six patients were available for Neck Disability Index via phone call at the time of the study. Results: Eight patients were included in the study. The mean age was 45.1 years ± 26.5. Causes of trauma included motor vehicle collision for five patients (5/8, 62.5%), falls for two (2/8, 25), and assault for one (1/8, 12.5%). All patients had a widened condyle-C1 interval >2 mm. Three patients underwent occipitocervical fusion, one patient underwent atlantoaxial fusion, and another received subaxial fusions for other injuries. Three patients underwent no surgical intervention. All patients were seen at least once as an outpatient following hospital discharge. There were no delayed neurologic injuries or deaths. Conclusions: We propose that ligamentous injury at the CCJ functions more as a spectrum rather than dichotomous diagnosis, of which a subset can likely be safely managed nonoperatively.

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“…Rib fractures are the most common injury following blunt thoracic trauma 1,2 and can lead to a range of complications, including pneumonia, 3 atelectasis, 4 and respiratory failure. These complications carry significant morbidity, often leading to extended ventilator time, 5 prolonged time in the intensive care unit (ICU) 6,7 and increased length of stay 8 . Early identification of patients at risk is essential for appropriate management and early intervention 9,10 .…”

mentioning

confidence: 99%

External validation of novel Revised Intensity Battle Score and comparison of static rib fracture scoring systems

Buchholz,

D’Aquila,

Lollar

2023

J Trauma Acute Care Surg

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Background This study aims to compare and externally validate the previously developed Revised Intensity Battle Score (RIBS) against other proposed scores for predicting poor outcomes after rib fractures. Methods An external validation set was assembled retrospectively, comprising 1493 adult patients with one or more rib fractures admitted to a Level 1 trauma center between 2019 and 2022. The following rib fracture scores were calculated for each patient: RIBS, Injury Severity Score, Rib Fracture Score, Chest Trauma Score and Battle score. Each was investigated to assess utility in predicting mortality, ICU upgrade, unplanned intubation and ventilator days. Performance was measured by area under the receiver operating characteristic curve. Results Of the 1493 patients who met inclusion criteria, 239 patients (16%) experienced one of more of the investigated outcomes. Generally, scores performed best at predicting mortality and ventilator days. The RIBS stood out as best predicting ‘any complication’ (AUC = 0.735) and ‘>7 ventilator days’ (AUC = 0.771). Conclusions The RIBS represents an externally validated triage score in patients with rib fractures and compares favorably to other static scoring systems. Use of this score as a triage tool may allow stratifying patients who may benefit from direct ICU admission, neuraxial anesthesia and aggressive respiratory care. Next steps include prospective investigation of how pairing these interventions with score directed triage impacts outcomes Level of Evidence Level V, Prognostic / epidemiological

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ICU Length of Stay and Factors Associated with Longer Stay of Major Trauma Patients with Multiple Rib Fractures: A Retrospective Observational Study

Cited by 4 publications

References 39 publications

Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents

Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents

Unilateral atlanto-occipital injury

External validation of novel Revised Intensity Battle Score and comparison of static rib fracture scoring systems

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