The Weight of Surgical Knowledge

Choi, Jeff; Stave, Christopher D; Spain, David A.

doi:10.1097/sla.0000000000005365

Cited by 9 publications

(7 citation statements)

References 13 publications

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“…Mirroring recent collaborations to identify SSRF candidates among patients with TBI, consensus effort could improve disseminating standardized definitions (e.g., CWIS taxonomy of rib fractures) and establish standardized criteria for SSRF indications. 19 *Timing thresholds: <72 hours (9), <48 hours (1), <24 hours (2), 24 to 96 hours (1), and "early" (1). **Displaced defined as follows: bicortical displacement ( 14), >50% displaced (7), ≥1 cm (1), risk of impaling surrounding structures (1), and >95% rib width (1).…”

Section: Discussionmentioning

confidence: 99%

“…19 *Timing thresholds: <72 hours (9), <48 hours (1), <24 hours (2), 24 to 96 hours (1), and "early" (1). **Displaced defined as follows: bicortical displacement ( 14), >50% displaced (7), ≥1 cm (1), risk of impaling surrounding structures (1), and >95% rib width (1).…”

Section: Discussionmentioning

confidence: 99%

“…‡Pain score thresholds: ≥5 (3), >5 (5), >4 (2). §Incentive spirometry volume thresholds: <75% predicted (3), <50% predicted (9), <500 mL (1), <900 mL/s (1), and decreasing (1).…”

Section: Discussionmentioning

confidence: 99%

“…S urgical stabilization of rib fractures (SSRF) has gained increasing interest over the past decade. 1 Improved clinical outcomes and cost-effectiveness associated with SSRF for patients with flail chest are well described, [2][3][4] and recent studies suggest that SSRF candidacy could be expanded to patients without flail chest and those previously deemed too old to undergo operative management. 5,6 Despite increasing frequency of SSRF 7 and a growing evidence base, clinical practice has yet to align with evidence.…”

mentioning

confidence: 99%

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Challenges in closing the gap between evidence and practice: International survey of institutional surgical stabilization of rib fractures guidelines

Choi

Badrinathan

Shine

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Surgical stabilization of rib fractures (SSRF) has gained increasing interest over the past decade, yet few candidates who could benefit from SSRF undergo operative management. We conducted an international survey of institutional SSRF guidelines comparing congruence between practice and contemporary evidence. We hypothesized that few guidelines reflect comprehensive evidence to facilitate standardized patient selection, operation, and postoperative management. METHODS:A request for institutional rib fracture guidelines was distributed from the Chest Wall Injury Society. Surgical stabilization of rib fractures-specific guideline contents were extracted using a priori-designed extraction sheets and compared against 28 SSRF evidence-based recommendations outlined by a panel of 14 international experts. Fisher's exact test compared the proportion of strong and weak evidence-based recommendations specified within a majority of institutional guidelines to evaluate whether strength of evidence is associated with implementation. RESULTS:A total of 36 institutions from 3 countries submitted institutional rib fracture management guidelines, among which 30 had SSRF-specific guidance. Twenty-eight guidelines (93%) listed at least one injury pattern criteria as an indication for SSRF, while 22 (73%) listed pain and 21 (70%) listed impaired respiratory function as other indications. Quantitative pain and respiratory function impairment thresholds that warrant SSRF varied across institutions. Few guidelines specified nonacute indications for SSRF or perioperative considerations. Seven guidelines (23%) detailed postoperative management but recommended timing and interval for follow-up varied. Overall, only 3 of the 28 evidence-based SSRF recommendations were specified within a majority of institutional practice guidelines. There was no statistically significant association (p = 0.99) between the strength of recommendation and implementation within institutional guidelines. CONCLUSION:Institutional SSRF guidelines do not reflect the totality of evidence available in contemporary literature. Guidelines are especially important for emerging interventions to ensure standardized care delivery and minimize low-value care. Consensus effort is needed to facilitate adoption and dissemination of evidence-based SSRF practices.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…‡Pain score thresholds: ≥5 (3), >5 (5), >4 (2). §Incentive spirometry volume thresholds: <75% predicted (3), <50% predicted (9), <500 mL (1), <900 mL/s (1), and decreasing (1).…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Challenges in closing the gap between evidence and practice: International survey of institutional surgical stabilization of rib fractures guidelines

Choi

Badrinathan

Shine

et al. 2022

J Trauma Acute Care Surg

Self Cite

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“…Surgical literature grows exponentially,2 yet unreliable and nonreplicable findings remain prevalent 3. Academic productivity is a byproduct of scientific inquiry but should not be the goal of research time.…”

Section: Define the Professional Missionmentioning

confidence: 99%