urpose: Chest traumas consist of approximately 10% of all trauma cases admitted to hospitals and is the second leading cause of trauma-related mortality, accounting for approximately 25% of all trauma-induced deaths. Rib fractures are the most common type of chest trauma, and rib fractures without a...
urpose: Chest traumas consist of approximately 10% of all trauma cases admitted to hospitals and is the second leading cause of trauma-related mortality, accounting for approximately 25% of all trauma-induced deaths. Rib fractures are the most common type of chest trauma, and rib fractures without an associated injury are reported to occur in 6–12%. Conventionally, they have been treated with a conservative approach focusing on pain control, pulmonary hygiene management, and ventilator care if necessary. In the last 20 years, with the advancement in surgical equipment and techniques, favorable outcomes of surgery have been reported, such as decreased occurrence of respiratory complication, reduced mortality rate, and shorter length of hospital stay. In most studies, however, study samples included heterogeneous groups of patients with associated injuries. Accordingly, in the present study, the study sample was limited to patients with rib fractures without an associated injury to compare surgical and conservative treatments for rib fractures.
Methods: Study subjects included 181 patients with rib fractures without an associated injury, other than bruises and abrasions, admitted to Pusan National University Hospital due to blunt force chest trauma between December 2013 and March 2018. Outcome measurements included the length of hospital and intensive care unit (ICU) stay, duration of ventilator care, tracheostomy, pneumonia, mortality rates, and chronic pain.
Result: Forty-four patients (39 males and 5 females) underwent rib fracture fixation during the study period. The clinical features were not different between the Operation and NOM (non-operation) groups, with an exception of diabetes mellitus (6.8% in the Operation group; 20.4% in the NOM group; p<0.05). However, large between-group differences were observed in injury scale scores, including abbreviated injury scores (AIS) (Operation group, 3.3±0.63; NOM group, 2.83±0.6; p<0.05), injury severity score (ISS) (Operation group, 11.84±4.6; NOM group, 9.07±3.80; <0.05), and the number of fractured ribs (Operation group, 6.01±2.61; NOM group, 3.61±2.27), requiring correction for further analysis. Gender, age, AIS and ISS scores, and the number of fractured ribs were corrected using propensity score matching, and data from 88 patients with the corrected scores (n=44 in Operation and NOM groups, respectively) were used in the subsequent analysis to compare the groups on tracheostomy, pneumonia, mortality rate, length of hospitalization and ICU stay, the duration of ventilator care, and changes in chronic pain and pulmonary function. In these patients, pneumonia, tracheostomy, mortality rate, and the duration of ventilator care did not show significant between-group differences. However, compared to the Operation group, the NOM group had a shorter length of hospital stay (Operation group, 17.27±6.62; NOM group, 10.41±8.34; p<0.05) and a shorter length of ICU stay (Operation group, 3.45±6.0; NOM group, 1.45±2.7; p<0.05), as well as lower occurrences of chronic pain (Operation group, 47.7%; NOM group, 9.1%; p<0.05). Early forced vital capacity (FVC) performances were significantly lower in the Operation group (Operation group, 54%; NOM group 64.5%; p0.05).
Conclusion: Outcomes regarding length of hospitalization and ICU stay along with chronic pain were less favorable in the Operation group due to the severity of injury, while the occurrences of complications were low relative to the injury scale scores. In particular, the Operation group showed rapid improvements in pulmonary function, suggesting the effectiveness of surgical treatment This study is significant in that heterogeneity in the study sample was minimized by limiting the sample to patients with rib fractures without an associated injury. However, it was a retrospective study and the sample size was small; thus, the findings on surgical treatment may be debatable. Hence, multi-institutional prospective research should be conducted to establish standard guidelines for the treatment of rib fractures.
urpose: Chest traumas consist of approximately 10% of all trauma cases admitted to hospitals and is the second leading cause of trauma-related mortality, accounting for approximately 25% of all trauma-induced deaths. Rib fractures are the most common type of chest trauma, and rib fractures without an associated injury are reported to occur in 6–12%. Conventionally, they have been treated with a conservative approach focusing on pain control, pulmonary hygiene management, and ventilator care if necessary. In the last 20 years, with the advancement in surgical equipment and techniques, favorable outcomes of surgery have been reported, such as decreased occurrence of respiratory complication, reduced mortality rate, and shorter length of hospital stay. In most studies, however, study samples included heterogeneous groups of patients with associated injuries. Accordingly, in the present study, the study sample was limited to patients with rib fractures without an associated injury to compare surgical and conservative treatments for rib fractures.
Methods: Study subjects included 181 patients with rib fractures without an associated injury, other than bruises and abrasions, admitted to Pusan National University Hospital due to blunt force chest trauma between December 2013 and March 2018. Outcome measurements included the length of hospital and intensive care unit (ICU) stay, duration of ventilator care, tracheostomy, pneumonia, mortality rates, and chronic pain.
Result: Forty-four patients (39 males and 5 females) underwent rib fracture fixation during the study period. The clinical features were not different between the Operation and NOM (non-operation) groups, with an exception of diabetes mellitus (6.8% in the Operation group; 20.4% in the NOM group; p<0.05). However, large between-group differences were observed in injury scale scores, including abbreviated injury scores (AIS) (Operation group, 3.3±0.63; NOM group, 2.83±0.6; p<0.05), injury severity score (ISS) (Operation group, 11.84±4.6; NOM group, 9.07±3.80; <0.05), and the number of fractured ribs (Operation group, 6.01±2.61; NOM group, 3.61±2.27), requiring correction for further analysis. Gender, age, AIS and ISS scores, and the number of fractured ribs were corrected using propensity score matching, and data from 88 patients with the corrected scores (n=44 in Operation and NOM groups, respectively) were used in the subsequent analysis to compare the groups on tracheostomy, pneumonia, mortality rate, length of hospitalization and ICU stay, the duration of ventilator care, and changes in chronic pain and pulmonary function. In these patients, pneumonia, tracheostomy, mortality rate, and the duration of ventilator care did not show significant between-group differences. However, compared to the Operation group, the NOM group had a shorter length of hospital stay (Operation group, 17.27±6.62; NOM group, 10.41±8.34; p<0.05) and a shorter length of ICU stay (Operation group, 3.45±6.0; NOM group, 1.45±2.7; p<0.05), as well as lower occurrences of chronic pain (Operation group, 47.7%; NOM group, 9.1%; p<0.05). Early forced vital capacity (FVC) performances were significantly lower in the Operation group (Operation group, 54%; NOM group 64.5%; p0.05).
Conclusion: Outcomes regarding length of hospitalization and ICU stay along with chronic pain were less favorable in the Operation group due to the severity of injury, while the occurrences of complications were low relative to the injury scale scores. In particular, the Operation group showed rapid improvements in pulmonary function, suggesting the effectiveness of surgical treatment This study is significant in that heterogeneity in the study sample was minimized by limiting the sample to patients with rib fractures without an associated injury. However, it was a retrospective study and the sample size was small; thus, the findings on surgical treatment may be debatable. Hence, multi-institutional prospective research should be conducted to establish standard guidelines for the treatment of rib fractures.
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