The number of displaced rib fractures is more predictive for complications in chest trauma patients

Chih-Ying Chien, Yu-Hsien Chen, Shih-Tsung Han, Gerald N Blaney, Ting-Shuo Huang, Kuan-Fu Chen, Chih-Ying Chien, Yu-Hsien Chen, Shih-Tsung Han, Gerald N Blaney, Ting-Shuo Huang, Kuan-Fu Chen

Abstract

Background: Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increase in chest complications.

Methods: We retrospectively reviewed the trauma registry between January 2013 and May 2015 in a teaching hospital in northeastern Taiwan. Patients admitted with chest trauma and rib fractures without concomitant severe brain, splenic, pelvic or liver injuries were included. The demographic data, such as gender, age, the index of coexistence disease, alcohol consumption, trauma mechanisms were analyzed as potential predictors of pulmonary complications. Pulmonary complications were defined as pneumothorax, hemothorax, flail chest, pulmonary contusion, and pneumonia.

Results: In the 29 months of the study period, a total of 3151 trauma patients were admitted to our hospital. Among them, 174 patients were enrolled for final analysis. The most common trauma mechanism was road traffic accidents (58.6%), mainly motorbike accidents (n = 70, 40.2%). Three or more displaced rib fractures had higher specificity for predicting complications, compared to three or more total rib fractures (95.5% vs 59.1%). Adjusting the severity of chest trauma using TTSS and Ribscore by multivariable logistic regression analysis, we found that three or more rib fractures or any displaced rib fracture was the most significant predictor for developing pulmonary complication (aOR: 5.49 95% CI: 1.82-16.55). Furthermore, there were 18/57 (31.6%) patients with fewer than three ribs fractures developed pulmonary complications. In these 18 patients, only five patients had delayed onset complications and four of them had at least one displaced rib fracture.

Discussion: In this retrospective cohort study, we found that the number of displaced or total rib fractures, bilateral rib fractures, and rib fractures in more than two areas were associated with the more chest complications. Furthermore, three or more rib fracture or any displacement were found to be the most sensitive risk factor for chest complications, independent of other risk factors or severity index.

Conclusion: The number of displaced rib fractures could be a strong predictor for developing pulmonary complications. For patients with fewer than three rib fractures without rib displacement and initial lung or other organ injuries, outpatient management could be safe and efficient.

Keywords: Chest Trauma; Complications; Displaced Rib Fractures; Hospitalization; Prognosis; Rib Fractures; Sensitivity and Specificity.

Figures

Fig. 1
Fig. 1
Flow chart of study
Fig. 2
Fig. 2
a Distribution of complication according to the number of rib fractures. b Distribution of complication according to the number of displaced rib fractures

References

    1. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975–9. doi: 10.1097/00005373-199412000-00018.
    1. Dreizin D, Munera F. Blunt polytrauma: evaluation with 64-section whole-body CT angiography. Radiographics. 2012;32(3):609–31. doi: 10.1148/rg.323115099.
    1. Sirmali M, Turut H, Topcu S, Gulhan E, Yazici U, Kaya S, Tastepe I. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 2003;24(1):133–8. doi: 10.1016/S1010-7940(03)00256-2.
    1. Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg. 2003;23(3):374–8. doi: 10.1016/s1010-7940(02)00813-8.
    1. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury. 2012;43(1):8–17. doi: 10.1016/j.injury.2011.01.004.
    1. Simon BJ, Chu Q, Emhoff TA, Fiallo VM, Lee KF. Delayed hemothorax after blunt thoracic trauma: an uncommon entity with significant morbidity. J Trauma. 1998;45(4):673–6. doi: 10.1097/00005373-199810000-00005.
    1. Chapman BC, Herbert B, Rodil M, Salotto J, Stovall RT, Biffl W, Johnson J, Burlew CC, Barnett C, Fox C, et al. RibScore: a novel radiographic score based on fracture pattern that predicts pneumonia, respiratory failure, and tracheostomy. J Trauma Acute Care Surg. 2016;80(1):95–101. doi: 10.1097/TA.0000000000000867.
    1. Daurat A, Millet I, Roustan JP, Maury C, Taourel P, Jaber S, Capdevila X, Charbit J. Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion. Injury. 2016;47(1):147–53. doi: 10.1016/j.injury.2015.08.031.
    1. Aukema TS, Beenen LF, Hietbrink F, Leenen LP. Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome. Open Access Emerg Med. 2011;3:49–53.
    1. Subcommittee A, American College of Surgeons’ Committee on T, International Awg Advanced trauma life support (ATLS(R)): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363–6.
    1. Miskulin DC, Athienites NV, Yan G, Martin AA, Ornt DB, Kusek JW, Meyer KB, Levey AS, Hemodialysis Study G. Comorbidity assessment using the Index of Coexistent Diseases in a multicenter clinical trial. Kidney Int. 2001;60(4):1498–510. doi: 10.1046/j.1523-1755.2001.00954.x.
    1. Baker SP, O’Neill B, Haddon W, Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96. doi: 10.1097/00005373-197403000-00001.
    1. Jorgensen K. Use of the abbreviated injury scale in a hospital emergency room. Potential for research in accident epidemiology. Acta Orthop Scand. 1981;52(3):273–7. doi: 10.3109/17453678109050103.
    1. Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma. 2000;49(3):496–504. doi: 10.1097/00005373-200009000-00018.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology. 2007;18(6):800–4. doi: 10.1097/EDE.0b013e3181577654.
    1. Livingston DH, Shogan B, John P, Lavery RF. CT diagnosis of Rib fractures and the prediction of acute respiratory failure. J Trauma. 2008;64(4):905–11. doi: 10.1097/TA.0b013e3181668ad7.
    1. Ho AM, Karmakar MK, Critchley LA. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques. Curr Opin Crit Care. 2011;17(4):323–7. doi: 10.1097/MCC.0b013e328348bf6f.
    1. Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003;54(3):615–25. doi: 10.1097/01.TA.0000053197.40145.62.
    1. Ceran S, Sunam GS, Aribas OK, Gormus N, Solak H. Chest trauma in children. Eur J Cardiothorac Surg. 2002;21(1):57–9. doi: 10.1016/S1010-7940(01)01056-9.
    1. Wilson RF, Murray C, Antonenko DR. Nonpenetrating thoracic injuries. Surg Clin North Am. 1977;57(1):17–36. doi: 10.1016/S0039-6109(16)41131-X.
    1. Poole GV, Jr, Myers RT. Morbidity and mortality rates in major blunt trauma to the upper chest. Ann Surg. 1981;193(1):70–5. doi: 10.1097/00000658-198101000-00012.
    1. Avila Martinez RJ, Hernandez Voth A, Marron Fernandez C, Hermoso Alarza F, Martinez Serna I, Mariscal de Alba A, Zuluaga Bedoya M, Trujillo MD, Meneses Pardo JC, Diaz Hellin V, et al. Evolution and complications of chest trauma. Arch Bronconeumol. 2013;49(5):177–80. doi: 10.1016/j.arbres.2012.12.005.

Source: PubMed

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