Predictors of mortality in patients with rib fractures

Marini, Corrado P.; Petrone, Patrizio; Soto-Sánchez, Ana; García-Santos, Esther; Stoller, Christy; Verde, Juan M.

doi:10.1007/s00068-019-01183-5

Cited by 35 publications

(23 citation statements)

References 19 publications

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“…5,[33][34][35] The majority of our patients had associated injuries that are clinically significant and linked with complications and increased mortality. 15,[36][37][38][39][40] Pneumothorax and/or hemothorax was prevalent in our patient cohort, which is just one example of how these injuries can lead to altered respiratory mechanics and chest wall instability. While it cannot be ascertained from our study whether the scapula and/ or rib fractures caused these associated injuries, our results show that it is extremely common for other traumatic injuries to be occurring in these patients.…”

Section: Discussionmentioning

confidence: 83%

Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures

Thomas

Lindquist

Paull

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Rib fractures occur in approximately 10% of trauma patients and are associated with more than 50% of patients with scapula fractures. This study investigates the location and patterns of rib fractures and flail chest occurring in patients with operatively treated scapula fractures. Novel frequency mapping techniques of rib fracture patterns in patients who also injure the closely associated scapula can yield insight into surgical approaches and fixation strategies for complex, multiple injuries patients. We hypothesize that rib fractures have locations of common occurrence when presenting with concomitant scapula fracture that requires operative treatment. METHODS:Patients with one or more rib fractures and a chest computed tomography scan between 2004 and 2018 were identified from a registry of patients having operatively treated scapula fractures. Unfurled rib images were created using Syngo-CT Bone Reading software (Siemens Inc., Munich, Germany). Rib fracture and flail segment locations were marked and measured for standardized placement on a two-dimensional chest wall template. Location and frequency were then used to create a gradient heat map. RESULTS:A total of 1,062 fractures on 686 ribs were identified in 86 operatively treated scapula fracture patients. The mean ± SD number of ribs fractured per patient was 8.0 ± 4.1 and included a mean ± SD of 12.3 ± 7.2 total fractures. Rib fractures ipsilateral to the scapula fracture occurred in 96.5% of patients. The most common fracture and flail segment location was ipsilateral and subscapular; 51.4% of rib fractures and 95.7% of flail segments involved ribs 3 to 6. CONCLUSION:Patients indicated for operative treatment of scapula fractures have a substantial number of rib fractures that tend to most commonly occur posteriorly on the rib cage. There is a pattern of subscapular rib fractures and flail chest adjacent to the thick bony borders of the scapula. This study enables clinicians to better evaluate and diagnose scapular fracture patients with concomitant rib fractures.

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Section: Discussionmentioning

confidence: 83%

Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures

Thomas

Lindquist

Paull

et al. 2021

J Trauma Acute Care Surg

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“…There were 50 studies of varying design and quality which investigated whether age was a risk factor for mortality in patients with blunt chest wall trauma (online supplemental file 3, table 1). Of these, 19 studies demonstrated a higher risk of mortality in patients aged 65 years or more when compared with patients aged less than 65 years 7 13–16 30–43. Other studies demonstrated that increased risk of mortality occurred in patients aged 50 years or more,17 55 years or more,44 45 60 years or more,46–50 70 years or more,51 80 years or more,52 and 90 years or more 53.…”

Section: Resultsmentioning

confidence: 99%

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

et al. 2022

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BackgroundOver the last 10 years, research has highlighted emerging potential risk factors for poor outcomes following blunt chest wall trauma. The aim was to update a previous systematic review and meta-analysis of the risk factors for mortality in blunt chest wall trauma patients.MethodsA systematic review of English and non-English articles using MEDLINE, Embase and Cochrane Library from January 2010 to March 2022 was completed. Broad search terms and inclusion criteria were used. All observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. Where sufficient data were available, ORs with 95% CIs were calculated using a Mantel-Haenszel method. Heterogeneity was assessed using the I2statistic.Results73 studies were identified which were of variable quality (including 29 from original review). Identified risk factors for mortality following blunt chest wall trauma were: age 65 years or more (OR: 2.11; 95% CI 1.85 to 2.41), three or more rib fractures (OR: 1.96; 95% CI 1.69 to 2.26) and presence of pre-existing disease (OR: 2.86; 95% CI 1.34 to 6.09). Other new risk factors identified were: increasing Injury Severity Score, need for mechanical ventilation, extremes of body mass index and smoking status. Meta-analysis was not possible for these variables due to insufficient studies and high levels of heterogeneity.ConclusionsThe results of this updated review suggest that despite a change in demographics of trauma patients and subsequent emerging evidence over the last 10 years, the main risk factors for mortality in patients sustaining blunt chest wall trauma remained largely unchanged. A number of new risk factors however have been reported that need consideration when updating current risk prediction models used in the ED.PROSPERO registration numberCRD42021242063. Date registered: 29 March 2021.https://www.crd.york.ac.uk/PROSPERO/%23recordDetails.

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“…[4][5][6] Alternatively, other groups have failed to identify a predictive relationship between the number of ribs fractured and reevaluation or readmission. 16,[20][21][22] While we were unable to perform comparative analyses regarding the specific number of ribs fractured, we did find a significantly higher incidence of rib fractures in the readmit PDPSC group compared with the no readmit group. In addition, mean number of total rib fractures in the readmit PDPSC group was 6, above the commonly used cutoff of 5.…”

Section: Discussionmentioning

confidence: 99%

Readmission for pleural space complications after chest wall injury: Who is at risk?

Kay¹,

Morris²,

Gardner³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND Little is known about patient characteristics predicting postdischarge pleural space complications (PDPSCs) after thoracic trauma. We sought to analyze the patient population who required unplanned hospital readmission for PDPSC. METHODS Retrospective review of adult patients admitted to a Level I Trauma Center with a chest Abbreviated Injury Scale (AIS) score of 2 or greater between January 2015 and August 2020. Those readmitted within 30 days of index hospitalization discharge for PDPSC were compared with those not readmitted. Demographics, injury characteristics, surgical procedures, imaging, and readmission data were retrieved. RESULTS Out of 17,192 trauma evaluations, 3,412 (19.8%) suffered a chest AIS score of 2 or greater injury and 155 experienced an unplanned 30-day hospital readmission. Of those, 49 (1.4%) were readmitted for the management of PDPSC (readmit PDPSC) and were compared with patients who were not readmitted (no readmit, n = 3,257). The readmit PDPSC group was significantly older age, heavier, comprised of fewer men, and suffered a higher mean chest AIS score. The readmit PDPSC group had a significantly higher incidence of rib fractures, flail chest, pneumothorax, hemothorax, scapula fractures, and a higher rate of tube thoracostomy placement during index admission. The discharge chest X-ray in the readmit PDPSC group demonstrated a pleural space abnormality in 36 (73%) of patients. Mean time to readmission was 10.2 (7.2) days, and hospital length of stay on readmission was 5.8 (3.7) days. Pleural effusion was the most common readmission diagnosis (44 [90%]), and 42 (86%) required tube thoracostomy. CONCLUSION We describe the subset of chest wall injury patients who require hospital readmission for PDPSC. Characteristics from index hospitalization associated with PDPSC include older age, female sex, heavier weight, presence of rib fractures, pleural space abnormality, scapular fracture, and chest tube placement. Further studies are needed to characterize this at-risk chest wall injury population, and to determine what interventions can facilitate outpatient management of postdischarge pleural space complications and mitigate readmission risk. LEVEL OF EVIDENCE Prognostic and epidemiologic, Level IV; Care management, Level V.

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Predictors of mortality in patients with rib fractures

Cited by 35 publications

References 19 publications

Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures

Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

Readmission for pleural space complications after chest wall injury: Who is at risk?

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