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Plate of ribs: single institution’s matched comparison of patients managed operatively and non-operatively for rib fractures
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  • Published on:
    Letter in response to “Plate of Ribs” by Griffard J, Daley B, Campbell M, et al.

    We read with great interest “Plate of ribs: single institution’s matched comparison of patients managed operatively and non-operatively for rib fractures” by Griffard et al (1). As chest injuries are one of the most prevalent injuries encountered in trauma care, the importance of evidence for or against treatments cannot be overlooked. The authors review their institution’s recent experience with surgical stabilization of rib fractures (SSRF) and draw comparisons to other patients with chest injuries cared for by their group. We found several methodological concerns (including propensity matching, injury phenotype heterogeneity, and selection bias) that arise from their design that may significantly affect their analysis and conclusions.

    To start, the authors reference three prior studies that use patient-matching to study operative vs. non-operative treatments of fractures. The authors indicate that they made a similar matched comparison; however, there was significant heterogeneity in the methods of the referenced studies. The first study used a 1:4 match of age, GCS, other surgeries, mechanical ventilation, pressors and transfusion requirement, but introduced selection bias by excluding tens of thousands of patients cared for at hospitals that did not use SSRF (2). The next study used a 1:1 match, excluding significant traumatic brain injury (TBI), spinal, and pelvic injuries or other injuries AIS =5, to match age, sex and thoracic AIS (3). This resulted i...

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    Conflict of Interest:
    None declared.