Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank
Background In recent years, there has been increasing interest in the treatment of patients with rib fractures. However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent. Furthermore, although it has been suggested that there is a large heterogene...
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| Format: | Article |
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BMJ Publishing Group
2020-12-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/5/1/e000441.full |
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| author | R Marijn Houwert Yassine Ochen Marilyn Heng Rolf H H Groenwold Jesse Peek Noelle Saillant Loek P H Leenen Tarsicio Uribe-Leitz |
| author_facet | R Marijn Houwert Yassine Ochen Marilyn Heng Rolf H H Groenwold Jesse Peek Noelle Saillant Loek P H Leenen Tarsicio Uribe-Leitz |
| author_sort | R Marijn Houwert |
| collection | DOAJ |
| description | Background In recent years, there has been increasing interest in the treatment of patients with rib fractures. However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent. Furthermore, although it has been suggested that there is a large heterogeneity among patients with traumatic rib fractures, there is insufficient literature reporting on the outcomes of different subgroups.Methods A retrospective cohort study using the National Trauma Data Bank was performed. All adult patients with one or more traumatic rib fractures or flail chest who were admitted to a hospital between January 2010 and December 2016 were identified by the International Classification of Diseases Ninth Revision diagnostic codes.Results Of the 564 798 included patients with one or more rib fractures, 44.9% (n=2 53 564) were patients with polytrauma. Two per cent had open rib fractures (n=11 433, 2.0%) and flail chest was found in 4% (n=23 388, 4.1%) of all cases. Motor vehicle accidents (n=237 995, 51.6%) were the most common cause of rib fractures in patients with polytrauma and flail chest. Blunt chest injury accounted for 95.5% (n=5 39 422) of rib fractures. Rib fractures in elderly patients were predominantly caused by high and low energy falls (n=67 675, 51.9%). Ultimately, 49.5% (n=2 79 615) of all patients were admitted to an intensive care unit, of whom a quarter (n=146 191, 25.9%) required invasive mechanical ventilatory support. The overall mortality rate was 5.6% (n=31 524).Discussion Traumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. Worse outcomes were predominantly observed among patients with polytrauma and flail chest. Future studies should recognize these differences and treatment should be evaluated accordingly.Level of evidence II/III. |
| format | Article |
| id | doaj-art-42349f875e884435a32f9a5e88fde6cb |
| institution | OA Journals |
| issn | 2397-5776 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-42349f875e884435a32f9a5e88fde6cb2025-08-20T02:12:25ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762020-12-015110.1136/tsaco-2020-000441Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data BankR Marijn Houwert0Yassine Ochen1Marilyn Heng2Rolf H H Groenwold3Jesse Peek4Noelle Saillant5Loek P H Leenen6Tarsicio Uribe-Leitz7Department of Surgery, University Medical Center Utrecht, Utrecht, The NetherlandsDepartment of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts, USADepartment of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USAprofessorTrauma Surgery, Universitair Medisch Centrum Utrecht, Utrecht, The NetherlandsDepartment of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts, USADepartment of Surgery, University Medical Center Utrecht, Utrecht, The NetherlandsProgram in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USABackground In recent years, there has been increasing interest in the treatment of patients with rib fractures. However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent. Furthermore, although it has been suggested that there is a large heterogeneity among patients with traumatic rib fractures, there is insufficient literature reporting on the outcomes of different subgroups.Methods A retrospective cohort study using the National Trauma Data Bank was performed. All adult patients with one or more traumatic rib fractures or flail chest who were admitted to a hospital between January 2010 and December 2016 were identified by the International Classification of Diseases Ninth Revision diagnostic codes.Results Of the 564 798 included patients with one or more rib fractures, 44.9% (n=2 53 564) were patients with polytrauma. Two per cent had open rib fractures (n=11 433, 2.0%) and flail chest was found in 4% (n=23 388, 4.1%) of all cases. Motor vehicle accidents (n=237 995, 51.6%) were the most common cause of rib fractures in patients with polytrauma and flail chest. Blunt chest injury accounted for 95.5% (n=5 39 422) of rib fractures. Rib fractures in elderly patients were predominantly caused by high and low energy falls (n=67 675, 51.9%). Ultimately, 49.5% (n=2 79 615) of all patients were admitted to an intensive care unit, of whom a quarter (n=146 191, 25.9%) required invasive mechanical ventilatory support. The overall mortality rate was 5.6% (n=31 524).Discussion Traumatic rib fractures are a marker of severe injury as approximately half of patients were patients with polytrauma. Furthermore, patients with rib fractures are a very heterogeneous group with a considerable difference in epidemiology, injury characteristics and in-hospital outcomes. Worse outcomes were predominantly observed among patients with polytrauma and flail chest. Future studies should recognize these differences and treatment should be evaluated accordingly.Level of evidence II/III.https://tsaco.bmj.com/content/5/1/e000441.full |
| spellingShingle | R Marijn Houwert Yassine Ochen Marilyn Heng Rolf H H Groenwold Jesse Peek Noelle Saillant Loek P H Leenen Tarsicio Uribe-Leitz Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank Trauma Surgery & Acute Care Open |
| title | Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank |
| title_full | Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank |
| title_fullStr | Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank |
| title_full_unstemmed | Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank |
| title_short | Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank |
| title_sort | traumatic rib fractures a marker of severe injury a nationwide study using the national trauma data bank |
| url | https://tsaco.bmj.com/content/5/1/e000441.full |
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