Central Surgical AssociationHalf-a-dozen ribs: The breakpoint for mortality
Section snippets
The National Trauma Data Bank
This study was performed by querying the National Trauma Data Bank (NTDB, v. 3.0).16 The NTDB is the most complete national database for injured patients currently available. It is maintained by the American College of Surgeons and includes data voluntarily submitted by trauma centers of all levels of designation. The data are subjected to quality checks using mechanisms that are part of the National Trauma Registry of the American College of Surgeons software and an additional logistic checks
Results
The NTDB (v 3.0) included 731,823 patients. Of these, 8.85% (n = 64,661) had a diagnosis of rib fracture(s) as identified by ICD-9 codes. Fewer patients, (6.5%; n = 47,658) were identified as having rib fractures using AIS codes. There were a total of 67,221 unique incidents (9.91%) identified by either the ICD-9 or AIS coding systems as having at least 1 rib fracture (Table). By using ICD-9 codes there were 19,295 patients (29.84%) with an unspecified number of fractured ribs, whereas 8,085
Discussion
Fractured ribs are seen as an isolated injury or in conjunction with other injuries in trauma patients. In this series, rib fractures occurred in 9% of all patients reported to the NTDB. This incidence corresponds with the rate observed at single trauma centers and suggests that the trauma centers contributing data to the NTDB are diagnosing this injury accurately.2, 3 When analyzing morbidity and mortality related to rib fractures, many variables must be taken into account. These include age,
Conclusion
Multiple rib fractures are a sign of major injury that correlates with mortality rate and pulmonary morbidity. When 6 or more ribs are fractured, mortality rate and associated injuries to the head and thorax are increased significantly. Epidural analgesia was associated with a reduction in mortality for all patients sustaining rib fractures, particularly those with more than 5 fractures, but appears to be underused.
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Presented at the 62nd Annual Meeting of the Central Surgical Association, Tucson, Arizona, March 10-15, 2005.