DOI QR코드

DOI QR Code

Outcomes after rib fractures: more complex than a single number

  • Kristin P., Colling (Department of Surgery, University of Minnesota Medical Center) ;
  • Tyler, Goettl (Department of Surgery, University of Minnesota Medical Center) ;
  • Melissa L., Harry (Essentia Institute of Rural Health)
  • 투고 : 2021.11.18
  • 심사 : 2022.02.16
  • 발행 : 2022.12.31

초록

Purpose: Rib fractures are common injuries that can lead to morbidity and mortality. Methods: Data on all patients with rib fractures admitted to a single trauma center between January 1, 2008 and December 31, 2018 were reviewed. Results: A total of 1,671 admissions for rib fracture were examined. Patients' median age was 57 years, the median Injury Severity Score (ISS) was 14, and the median number of fractured ribs was three. The in-hospital mortality rate was 4%. Age, the number of rib fractures, and Charlson Comorbidity Index scores were poor predictors of mortality, while the ISS was a slightly better predictor, with area under the receiver operating characteristic curve values of 0.60, 0.55, 0.58, and 0.74, respectively. Multivariate regression showed that age, ISS, and Charlson Comorbidity Index score, but not the number of rib fractures, were associated with significantly elevated adjusted odds ratios for mortality (1.03, 1.14, and 1.28, respectively). Conclusions: Age, ISS, and comorbidities were independently associated with the risk of mortality; however, they were not accurate predictors of death. The factors associated with rib fracture mortality are complex and cannot be explained by a single variable. Interventions to improve outcomes must be multifaceted.

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참고문헌

  1. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma 1994;37:975-9. https://doi.org/10.1097/00005373-199412000-00018
  2. Sirmali M, Turut H, Topcu S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg 2003;24:133-8. https://doi.org/10.1016/S1010-7940(03)00256-2
  3. Dunham CM, Hileman BM, Ransom KJ, Malik RJ. Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries. Int J Burns Trauma 2015;5:46-55.
  4. Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery 2005;138:717-25. https://doi.org/10.1016/j.surg.2005.07.022
  5. Murphy CE 4th, Raja AS, Baumann BM, et al. Rib fracture diagnosis in the panscan era. Ann Emerg Med 2017;70:904-9. https://doi.org/10.1016/j.annemergmed.2017.04.011
  6. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma 2000;48:1040-7. https://doi.org/10.1097/00005373-200006000-00007
  7. Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma 2003;54:478-85. https://doi.org/10.1097/01.TA.0000037095.83469.4C
  8. Shorr RM, Rodriguez A, Indeck MC, Crittenden MD, Hartunian S, Cowley RA. Blunt chest trauma in the elderly. J Trauma 1989;29:234-7. https://doi.org/10.1097/00005373-198902000-00016
  9. Schmoekel N, Berguson J, Stassinopoulos J, Karamanos E, Patton J, Johnson JL. Rib fractures in the elderly: physiology trumps anatomy. Trauma Surg Acute Care Open 2019;4:e000257. https://doi.org/10.1136/tsaco-2018-000257
  10. Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am Coll Surg 2003;196:549-55. https://doi.org/10.1016/S1072-7515(02)01894-X
  11. Tignanelli CJ, Rix A, Napolitano LM, Hemmila MR, Ma S, Kummerfeld E. Association between adherence to evidence-based practices for treatment of patients with traumatic rib fractures and mortality rates among US trauma centers. JAMA Netw Open 2020;3:e201316. https://doi.org/10.1001/jamanetworkopen.2020.1316
  12. Shi HH, Esquivel M, Staudenmayer KL, Spain DA. Effects of mechanism of injury and patient age on outcomes in geriatric rib fracture patients. Trauma Surg Acute Care Open 2017;2:e000074. https://doi.org/10.1136/tsaco-2016-000074
  13. Economic Research Service. Documentation: 2010 rural-urban commuting area (RUCA) codes [Internet]. Washington DC: US Department of Agriculture; 2019 [cited 2020 Dec 20]. Available from: https://www.ers.usda.gov/data-products/ rural-urban-commuting-area-codes/documentation.
  14. Centers for Medicare & Medicaid Services (CMS). Critical access hospital [Internet]. Baltimore, MD: CMS; 2022 [cited 2022 Jan 3]. Available from: https://www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/CritAccessHospfctsht.pdf.
  15. American College of Surgeons (ACS). National Trauma Data Standard data dictionary 2021 admissions [Internet]. Chicago, IL: ACS; 2020 [cited 2020 Dec 21]. Available from: https://indd.adobe.com/view/d9ca99df-fda7-4991-ad99-a8cecf848965.
  16. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing 2006;35:526-9. https://doi.org/10.1093/ageing/afl041
  17. Whitson BA, McGonigal MD, Anderson CP, Dries DJ. Increasing numbers of rib fractures do not worsen outcome: an analysis of the National Trauma Data Bank. Am Surg 2013;79:140-50. https://doi.org/10.1177/000313481307900224
  18. Hill AD, Fowler RA, Nathens AB. Impact of interhospital transfer on outcomes for trauma patients: a systematic review. J Trauma 2011;71:1885-901. https://doi.org/10.1097/TA.0b013e31823ac642
  19. Carr BG, Caplan JM, Pryor JP, Branas CC. A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care 2006;10:198-206. https://doi.org/10.1080/10903120500541324
  20. Barry R, Thompson E. Outcomes after rib fractures in geriatric blunt trauma patients. Am J Surg 2018;215:1020-3. https://doi.org/10.1016/j.amjsurg.2018.03.011
  21. Poulton A, Shaw JF, Nguyen F, et al. The association of frailty with adverse outcomes after multisystem trauma: a systematic review and meta-analysis. Anesth Analg 2020;130:1482-92. https://doi.org/10.1213/ANE.0000000000004687