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Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank
  1. Jesse Peek1,2,
  2. Yassine Ochen1,2,
  3. Noelle Saillant1,
  4. Rolf H H Groenwold3,
  5. Loek P H Leenen2,
  6. Tarsicio Uribe-Leitz4,
  7. R Marijn Houwert2,
  8. Marilyn Heng1
  1. 1Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Department of Clinical Epidemiology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
  4. 4Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Marilyn Heng; mheng{at}mgh.harvard.edu

Abstract

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 However, the current literature on the epidemiology and outcomes of rib fractures is outdated and inconsistent.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.

  • thoracic injuries
  • rib fractures
  • epidemiology
  • outcomes
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Footnotes

  • Contributors All authors contributed to the completion of this study, with the study design, data collection and analysis or writing and editing of the article. Study design: JP, YO, RHHG, LPHL, RMH, MH. Data assembly: JP, YO, TU-L. Data analysis and interpretation: JP, YO, RHHG, LPHL, TU-L, RMH, MH. Initial draft: JP, YO, MH. Critical revisions: NS, RHHG, LPHL, TU-L, RMH, MH. Final approval of manuscript: JP, YO, NS, RHHG, LPHL, TU-L, RMH, MH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Institutional Review Board of our institution (Partners Human Research Committee) approved this study under protocol #2018P001258/PHS. A waiver of consent was approved by our institutional review board due to the anonymous nature of the collected data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The data used to support the findings of this study are restricted by The National Trauma Databank of The American College of Surgeons. Data are available from the National Trauma Databank for researchers who meet the criteria for access to confidential data. Requests for access to these data should be made to The National Trauma Databank.

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