scholarly journals First rib fractures as indicators of serious intra and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality

2019 ◽  
Vol 6 (4) ◽  
pp. 1056
Author(s):  
Majed Al-Mourgi
Keyword(s):  
Cervical Spine ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Morbidity And Mortality ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Thoracic Injuries ◽  
First Rib

Background: First-rib fractures are relatively rare compared with fractures of other ribs because of the broad structure deeply placed and protected location of the first rib. A high amount of energy is needed to cause a first-rib fracture; violent trauma, such as that involving motor vehicle accident, is a frequent cause of these fractures, as well as other serious intra-thoracic, head, cervical spine, and intra-abdominal injuries. First-rib fractures have traditionally been considered indicators of increased injury severity and mortality in major trauma patients. The aim was to study the significance of first-rib fractures as indicators of serious intra-thoracic and extra-thoracic injury in polytrauma and their impact on the morbidity and mortality in a high-altitude area in Al-Taif, Saudi Arabia.Methods: This is a retrospective study conducted in King Abdul-Aziz Specialist Hospital (KASH), Taif City, KSA. Patients with chest injuries who presented to the emergency department and were admitted to the hospital between November 2013 and March 2016 were included in the study. Data regarding first-rib fracture were collected, and the relationship between first-rib injuries and associated intra-thoracic and extra-thoracic injuries was analyzed.Results: There was a high incidence of first-rib fracture (23.45%), and 35.8% were bilateral. The most common associated chest injury was a pulmonary contusion (58.5%), followed by pneumothorax (32.1%), hemopneumothorax (20.7%), and surgical emphysema (20.7%). The most common associated extra-thoracic injuries in our study were skeletal injuries (47.4%), cervical spine injuries (11.3%), and head trauma (24.5%).Conclusions: Fractures of the first-rib are associated with serious thoracic and extra-thoracic injuries; they are associated only with increased morbidity in patients with polytrauma and have no independent impact on mortality.

Injuries to the Chest Part 1

2019 ◽  
Author(s):  
Erika B. Call ◽  
Amy N. Hildreth ◽  
J. Jason Hoth
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Resuscitative Thoracotomy ◽  
Pulmonary Laceration ◽  
Tracheobronchial Injury ◽  
Early Trauma

Thoracic injury is common and is associated with significant morbidity and mortality. Injuries to the chest are responsible for 25% of blunt trauma fatalities and contribute to an additional 50% of deaths in this population.1 Fortunately, the majority of thoracic injuries can be treated effectively, and often definitively, by relatively simple maneuvers that can be learned and performed by most physicians involved in early trauma care. Only 5 to 10% will require operative intervention.2 These extremes in injury severity are unique to the chest and require treatment by a surgeon with a correspondingly broad range of knowledge and skills.  This article will address the following procedures and injuries:  tube thoracostomy, thoracotomy, emergency department resuscitative thoracotomy, video-assisted thoracoscopy, chest wall injuries including rib fractures and flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion and laceration, and tracheobronchial injury. This review 6 figures, 1 table, and 49 references. Keywords: Tube thoracoscopy, emergency department resuscitative thoracotomy (EDRT), rib fractures, flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion, pulmonary laceration, tracheobronchial injury

Injuries to the Chest Part 1

2019 ◽  
Author(s):  
Erika B. Call ◽  
Amy N. Hildreth ◽  
J. Jason Hoth
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Resuscitative Thoracotomy ◽  
Pulmonary Laceration ◽  
Tracheobronchial Injury ◽  
Early Trauma

Thoracic injury is common and is associated with significant morbidity and mortality. Injuries to the chest are responsible for 25% of blunt trauma fatalities and contribute to an additional 50% of deaths in this population.1 Fortunately, the majority of thoracic injuries can be treated effectively, and often definitively, by relatively simple maneuvers that can be learned and performed by most physicians involved in early trauma care. Only 5 to 10% will require operative intervention.2 These extremes in injury severity are unique to the chest and require treatment by a surgeon with a correspondingly broad range of knowledge and skills.  This article will address the following procedures and injuries:  tube thoracostomy, thoracotomy, emergency department resuscitative thoracotomy, video-assisted thoracoscopy, chest wall injuries including rib fractures and flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion and laceration, and tracheobronchial injury. This review 6 figures, 1 table, and 49 references. Keywords: Tube thoracoscopy, emergency department resuscitative thoracotomy (EDRT), rib fractures, flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion, pulmonary laceration, tracheobronchial injury

Decreased Incidence of Rib Fractures in Pregnant Patients After Motor Vehicle Collisions

2021 ◽  
Vol 30 (5) ◽  
pp. 385-390
Author(s):  
Marissa Di Napoli ◽  
William B. DeVoe ◽  
Stuart Leon ◽  
Bruce Crookes ◽  
Alicia Privette ◽  
...  
Keyword(s):  
Chest Wall ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Rib Fractures ◽  
Hormonal Changes ◽  
Motor Vehicle Collisions ◽  
Vehicle Collisions ◽  
Vehicle Collision ◽  
Chest Wall Injury ◽  
Wall Injury

Background Rib fractures are common after motor vehicle collisions. The hormonal changes associated with pregnancy decrease the stiffness and increase the laxity of cartilage and tendons. The effect of these changes on injury mechanics is not completely understood. Objectives To compare the incidences of chest wall injury following blunt thoracic trauma between pregnant and nonpregnant women. Methods The authors conducted a retrospective review of female patients seen at a level I trauma center from 2009 to 2017 after a motor vehicle collision. Patient characteristics were compared to determine if pregnancy affected the incidence of chest wall injury. Statistics were calculated with SPSS version 24 and are presented as mean (SD) or median (interquartile range). Results In total, 1618 patients were identified. The incidence of rib/sternal fracture was significantly lower in pregnant patients (7.9% vs 15.2%, P = .047), but the incidence of intrathoracic injury was similar between the groups. Pregnant and nonpregnant patients with rib/sternal fractures had similar Injury Severity Score results (21 [13-27] vs 17 [11-22], P = .36), but pregnant patients without fractures had significantly lower scores (1 [0-5] vs 4 [1-9], P < .001). Conclusions Pregnant patients have a lower rate of rib fracture after a motor vehicle collision than nonpregnant patients. The difference in injury mechanics may be due to hormonal changes that increase elasticity and resistance to bony injury of the ribs. In pregnant trauma patients, intrathoracic injury without rib fracture should raise concerns about injury severity. A multicenter evaluation of these findings is needed.

Perils of Rib Fractures

2008 ◽  
Vol 74 (4) ◽  
pp. 310-314 ◽  
Author(s):  
Om P. Sharma ◽  
Michael F. Oswanski ◽  
Shashank Jolly ◽  
Sherry K. Lauer ◽  
Rhonda Dressel ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Rib Fractures ◽  
Trauma Patients ◽  
Close Observation ◽  
Motorcycle Crashes ◽  
Level 1 Trauma Center

Rib fractures (RF) are noted in 4 to 12 per cent of trauma admissions. To define RF risks at a Level 1 trauma center, investigators conducted a 10-year (1995–2004) retrospective analysis of all trauma patients. Blunt chest trauma was seen in 13 per cent (1,475/11,533) of patients and RF in 808 patients (55% blunt chest trauma, 7% blunt trauma). RF were observed in 26 per cent of children (<18 years), 56 per cent of adults (18–64 years), and 65 per cent of elderly patients (≥65 years). RF were caused by motorcycle crashes (16%, 57/347), motor vehicle crashes (12%, 411/3493), pedestrian-auto collisions (8%, 31/404), and falls (5%, 227/5018). Mortality was 12 per cent (97/808; children 17%, 8/46; adults 9%, 46/522; elderly 18%, 43/240) and was linearly associated with a higher number of RF (5% 1–2 RF, 15% 3–5 RF, 34% ≥6 RF). Elderly patients had the highest mortality in each RF category. Patients with an injury severity score ≥15 had 20 per cent mortality versus 2.7 per cent with ISS <15 ( P < 0.0001). Increasing age and number of RF were inversely related to the percentage of patients discharged home. ISS, age, number of RF, and injury mechanism determine patients’ course and outcome. Patients with associated injuries, extremes of age, and ≥3 RF should be admitted for close observation.

The Combined Effects of Impact Direction and Impact Location on Serious-to-Maximum Injuries Among Drivers in Motor Vehicle Frontal Crashes

2016 ◽  
Author(s):  
Peiyu Li ◽  
Chunsheng Ma ◽  
Kai Zhang ◽  
Longli Shi ◽  
Jinhuan Zhang
Keyword(s):  
Motor Vehicle ◽  
The United States ◽  
Thoracic Injury ◽  
United States Department ◽  
Crash Severity ◽  
Combined Effects ◽  
Thoracic Injuries ◽  
Sampling System ◽  
Impact Location ◽  
Logistic Regressions

This paper investigates the combined effects of specific impact direction and impact location on the serious-to-maximum (AIS3–6) thoracic injuries of drivers in frontal impacts based on the 1995–2009 data from the United States Department of Transportation (US DOT) National Automotive Sampling System/Crashworthiness Data System (NASS/CDS). The selected sample is limited to three impact locations near the driver side (distributed, offset and corner) and two impact directions (pure frontal and oblique) treated as the frontal direction, resulting in a total of six crash configurations. The risks of thoracic injury for drivers in all frontal crash configurations are evaluated. The relative risks with 95% confidence intervals are calculated. Binary logistic regressions are fitted to the datasets for further examination of the effects of impact direction and impact location on the serious-to-maximum thoracic injuries. Occupant characteristics and crash severity are also included as explanatory variables. Overall, impact location and impact direction have considerable influences on thoracic injury pattern and severity for drivers. For distributed and corner deformation, oblique loading is approximately 3 times more likely to lead to thoracic injures than pure frontal loading. Conversely, the relative risk is 3.44 for offset deformation, which indicates that, for this impact location, frontal impact is more associated thoracic injuries compared to oblique impact. The effects of impact location and impact direction on serious-to-maximum injuries for three types of anatomical structures (organ, skeletal and vessel) are assessed as well. In addition to crash related variables (impact location and impact direction), results of the binary logistic regressions also indicate that crash severity (OR, 7.67–81.35) and occupant characteristics, including age (OR, 4.80–20.83), gender (OR, 1.16) and BMI (OR, 1.81), significantly affect the risks of thoracic injuries in frontal motor vehicle collisions.

scholarly journals Diagnostic modalities x-ray and CT chest differ in the management of thoracic injury

2015 ◽  
Vol 10 (1) ◽  
pp. 22-31
Author(s):  
D Chapagain ◽  
DJ Reddy ◽  
S Shah ◽  
KG Shrestha
Keyword(s):  
Ct Scan ◽  
Motor Vehicle ◽  
Rib Fracture ◽  
Lung Contusion ◽  
Thoracic Injury ◽  
Common Mechanism ◽  
Early Management ◽  
X Ray ◽  
Icu Stay ◽  
Chest X Ray

Objective: To observe difference in the management of blunt trauma to the chest on the basis of conventional xray and computerised tomography of the chest. Methods: This prospective study was conducted between December 2011 to October 2012 in COMS in Bharatpur,a tertiary referral centre in central Nepal . Clinically stable thoracic injury patients were first evaluated with chest x-ray and the management on this basis was recorded. The findings of the CT chest were assessed and the type of management on the basis of CT was also recorded. Outcome was assessed in terms of mortality, morbidity, hospital and ICU stay with respect to the management on the basis of chest x-ray and CT scan. Results: Of the 129 patients, 74.4% were male and 25.6% were female with the patients ranging in age from 7 to 87 years (mean = 40.41 years). The most common mechanism of trauma to the chest was as a result of a motor vehicle accident (69.8%), followed by fall injury (20.2%). X-ray chest diagnosed rib fracture in 62%, haemothorax in 37%, pneumothorax in 27%, lung contusion in 10% and haemopneumothorax in 21% patients. Similarly CT chest diagnosed rib fracture in 86%, haemothorax in 54%, pneumothorax in 36%, lung contusion in 30% and haemopneumothorax in 30% patients. Mean hospital stay was 9.5 days in the group of patients having management on the basis of x-ray chest relative to mean stay of 10.2 days in the CT- chest group. In the management on the basis of xray group, there was a mean ICU stay of 2.8days compared to mean stays of 3.2 days in CT chest group. Conclusion: Though CT scan of the chest is more informative and differs the management of the blunt chest trauma, one should not forget to advise the cost effective, easily available and initial guiding agent, xray chest for early management of the chest injury patient. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12764 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1); 22-31

scholarly journals P085: Potential benefits of incentive spirometry following a rib fracture: a propensity-score analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S87-S87
Author(s):  
M. Emond ◽  
A. Laguë ◽  
B. Batomen Kuimi ◽  
V. Boucher ◽  
C. Guimont ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Pulmonary Complications ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Thoracic Injury ◽  
Main Complaint ◽  
Score Analysis ◽  
Discharged Patients ◽  
Incentive Spirometry

Introduction: Incentive spirometry (IS) is commonly used in post-operative patients for respiratory recovery. Literature suggest that it can possibly improve lung function and reduce post-operative pulmonary complication. There is no recommendation about the use of IS in the emergency department (ED). However, rib fractures, a common complaint, increase the risk of pulmonary complications. There is heterogeneous ED practice for the management of rib fractures. The objective of this study is to assess the benefits of IS to reduce potential delayed complications in ED discharged patients with confirmed rib fracture. Methods: This is a prospective observational planned sub-study in 4 canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with a main complaint of minor thoracic injury and at least one suspected/confirmed rib fracture on radiographs were included. Discharge recommendations of IS use was left to attending physician. IS training was done by ED nurses. Main outcomes were pneumonia, atelectasis and hemothorax within 14 days. Analyses were made with propensity score matching. Results: 450 patients with at least one rib fracture were included. Of these, 182 (40%) received IS with a mean age of 57.0 y.o. Patients with IS seem to have worse condition. 61 (33.5%) had 3 fractures comparatively to 56 (20.9) for patient without IS. Although, the groups were similar for mean age, sex and mechanism of injury. There were in total 76 cases of delayed hemothorax (16.9%), 69 cases of atelectasis (15.3%) and five cases of pneumonia (1.1%). The use of IS was not protector for delayed hemothorax (RR= 0.80, 95% CI [0.45 1.36]) and nor for atelectasis or pneumonia (RR=0.74, 95% CI [0.45 1.36]) Conclusion: Our results suggest that unsupervised and broad incentive spirometry use does not seem to add a protective effect against the development of delayed pulmonary complications after a rib fracture. Further study should be made to assess the usefulness of IS in specific injured population in the ED.

scholarly journals New horizons in rib fracture management in the older adult

2019 ◽  
Vol 49 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Roisin Coary ◽  
Conor Skerritt ◽  
Anthony Carey ◽  
Sarah Rudd ◽  
David Shipway
Keyword(s):  
Older Adults ◽  
Injury Severity ◽  
Scoring Systems ◽  
Pulmonary Complications ◽  
Research Literature ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Mortality And Morbidity ◽  
Severity Scores ◽  
Fracture Management

Abstract Adults aged ≥60 years now represent the majority of patients presenting with major trauma. Falls are the most common cause of injury, accounting for nearly three-quarters of all traumas in this population. Trauma to the thorax represents the second most common site of injury in this population, and is often associated with other serious injuries. Mortality rates are 2–5 times higher in older adults compared to their younger counterparts, often despite equivalent injury severity scores. Risk scoring systems have been developed to identify rib fracture patients at high risk of deterioration. Overall mortality from rib fractures is high, at approximately 10% for all ages. Mortality and morbidity from rib fractures primarily derive from pain-induced hypoventilation, pneumonia and respiratory failure. The main goal of care is therefore to provide sufficient analgesia to allow respiratory rehabilitation and prevent pulmonary complications. The provision of analgesia has evolved to incorporate novel regional anaesthesia techniques into conventional multimodal analgesia. Analgesia algorithms may aid early aggressive management and escalation of pain control. The current role for surgical fixation of rib fractures remains unclear for older adults who have been underrepresented in the research literature. Older adults with rib fractures often have multi-morbidity and frailty which complicate their injuries. Trauma services are evolving, and increasingly geriatricians will be embedded into trauma services to deliver comprehensive geriatric assessment. This review aims to provide an evidence-based overview of the management of rib fractures for the physician treating older patients who have sustained trauma.

scholarly journals Predictive Factors of Ventilatory Support in Chest Trauma

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1154
Author(s):  
Silvia Fattori ◽  
Elisa Reitano ◽  
Osvaldo Chiara ◽  
Stefania Cimbanassi
Keyword(s):  
Predictive Factors ◽  
Thoracic Trauma ◽  
Univariate Analysis ◽  
Ventilatory Support ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

This study aims to define possible predictors of the need of invasive and non-invasive ventilatory support, in addition to predictors of mortality in patients with severe thoracic trauma. Data from 832 patients admitted to our trauma center were collected from 2010 to 2017 and retrospectively analyzed. Demographic data, type of respiratory assistance, chest injuries, trauma scores and outcome were considered. Univariate analysis was performed, and binary logistic regression was applied to significant data. The injury severity score (ISS) and the revised trauma score (RTS) were both found to be predictive factors for invasive ventilation. Multivariate analysis of the anatomical injuries revealed that the association of high-severity thoracic injuries with trauma in other districts is an indicator of the need for orotracheal intubation. From the analysis of physiological parameters, values of systolic blood pressure, lactate, and Glasgow coma scale (GCS) score indicate the need for invasive ventilatory support. Predictive factors for non-invasive ventilation include: RTS, ISS, number of rib fractures and presence of hemothorax. Risk factors for death were: age over 65, the presence of bilateral rib fractures, pulmonary contusion, hemothorax and associated head trauma. In conclusion, the need for invasive ventilatory support in thoracic trauma is associated to the patient’s systemic severity. Non-invasive ventilation is a supportive treatment indicated in physiologically stable patients regardless of the severity of thoracic injury.

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