scholarly journals Rib fractures, a public health issue-a multi regional retrospective study

2021 ◽  
Vol 17 (1) ◽  
pp. 14-19
Author(s):  
Irina Drăgan ◽  
Ioan Adrian Petrache ◽  
Valerian Cristian Păvăloiu ◽  
Petruț Giuliano ◽  
Ion Mîndrilă ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Individual Case ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Public Health Issue ◽  
Average Hospital Stay ◽  
Average Hospital ◽  
Social Reintegration ◽  
Multiple Rib Fractures ◽  
Total Average

We performed a retrospective study focusing on examining all rib fracture cases discharged from 4 thoracic surgery clinics in Romania. Over a period of 3 years, we analyzed data regarding the patients, diagnosis and number of days spent in the hospital. 2.417 patients were included in this study and all patient evolutions were taken into account. The most patients suffered from multiple rib fractures, involving four or more ribs. In total average hospital stay was 5.46 days. The pneumothorax was the most common encountered complication followed by hemo-pneumothorax, hemothorax and lung contusion. Men seem to be at a higher risk to develop a rib fracture than women. Fracture incidence increased with age in both sexes. The main goal when treating thoracic traumatic pathology is attaining less impairment of pulmonary functions and fast social reintegration. Management of rib fractures must be tailored to each individual case.

scholarly journals Management of multiple rib fractures-results from a Major Trauma Centre with review of the existing literature

2020 ◽  
Author(s):  
Debkumar Chowdhury ◽  
P. Okoh ◽  
H. Dambappa
Keyword(s):  
Major Trauma ◽  
Significant Proportion ◽  
Fragility Fractures ◽  
Trauma Centre ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Analgesic Requirement ◽  
Multiple Rib Fractures ◽  
Major Trauma Centre ◽  
The Impact

Abstract Introduction Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. It accounts for more than 15% of ED presentations (1) on a global scale. As the population ages the incidence of rib fractures also rises often following falls from a relatively small height being part of fragility fractures. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.Aim To assess our current management of rib fractures at our trauma centreMethod We collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. We also studied the number of rib fracture stabilisation procedures and the average number of ribs fixed.Results The data was collected retrospectively over a period of 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.Conclusion The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

scholarly journals Affections Neuroméningées Au Cours Du VIH Dans Le Service Des Maladies Infectieuses Du CHU De Brazzaville : Prévalence Et Facteurs Associés Au Décès

2016 ◽  
Vol 12 (33) ◽  
pp. 177
Author(s):  
Ossibi Ibara Bienvenu Rolland ◽  
, Obengui ◽  
Damba Banzouzi Bébene ◽  
Ossou-Nguiet Paul Macaire ◽  
Paka Herdan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Early Detection ◽  
Sex Ratio ◽  
Diagnosis Delay ◽  
Average Hospital Stay ◽  
Average Hospital ◽  
Factors Associated ◽  
Cerebral Herniation ◽  
Hiv 1 ◽  
Overall Mortality

Goal . Neuromeningeal determine the prevalence of disease in PLHIV and identify factors associated with death. Methodology. Retrospective study on descriptive and analytical referred cases hospitalized in the Infectious Diseases department during the period 1 January 2013 to 31 May 2015. Results. One hundred and fifty patients included (10.5% of admissions) with mean age of 41.1 ± 11.8 years (range 19 to 69) women (n = 86, 57.3%), sex ratio of 1,3. were without jobs (n = 68; 45.3%), single (n = 96; 64%), heterosexually infected by HIV-1 (100%). The average time of consultation was 19.2 ± 1.3 days. Fever (n = 99; 66.0%), disorders of consciousness (n = 66; 44.0%) were the main reasons for consultations. Meningeal stiffness (40%), focal signs (n =62; 41,4%) were the main signs consideration. CSF was clear (n = 94; 62.7%), hyperproteinorachique (59.8%), hypoglycorrachique (43.8%). Examining the ink was positive in 39 cases (34.8%) The Gerh was positive in 35 patients .the CT abnormalities were dominated abscess (n = 12; 15.4%).. Thirty four patients were on TDF + FTC + EFV regimen. The average hospital stay was 14.4 ± 9.5 days. Overall mortality was 83.2% mainly due to cerebral herniation (n = 28; 33.3%). Conclusion. The prevalence and lethality of diseases neuromeningeal of HIV are high. The diagnosis delay and TNM influence the prognosis of patients; Hence the importance of early detection of HIV infection for its management to prevent immunosuppression.

scholarly journals Testing the clinical validity of the Bemelman Rib Fracture Management Guideline

2020 ◽  
Vol 30 (4) ◽  
pp. 597-599
Author(s):  
Jessica R Dorman ◽  
Peter T M Clarke ◽  
Rosalind B Simpson ◽  
John G Edwards
Keyword(s):  
Rib Fractures ◽  
Rib Fracture ◽  
Management Guideline ◽  
Predictive Values ◽  
Multiple Rib Fractures ◽  
Fracture Management ◽  
Computed Tomography Scans ◽  
Surgical Fixation ◽  
A Prospective Study ◽  
Selection Algorithms

Abstract Whilst surgical stabilization of rib fractures (SSRF) results in better outcomes, selection algorithms are lacking. We aimed to validate the Rib Fracture Management Guideline proposed by Bemelman. From a cohort of 792 patients with multiple rib fractures, 2 sequential cohorts were selected: 48 patients who underwent SSRF and 48 patients who managed conservatively. Admission computed tomography scans and records were reviewed by an investigator blinded to the SSRF outcome. Adherence to the Bemelman guideline, revised to take account of consensus rib fracture definitions, was tested. Fifty-seven patients had multiple rib fractures only, and 39 patients also had a flail segment. Thirty-nine patients with flail segment underwent SSRF, and 18 patients were managed conservatively. Of the patients that the guideline predicted should have received surgery, 87% did. Of those that it predicted should not receive SSRF, 98% did not. The guideline displayed a sensitivity (95% confidence interval) and specificity for predicting the fixation of 0.98 (0.89–0.9995) and 0.83 (0.70–0.93), respectively. The positive and negative predictive values for surgical fixation were 0.87 (0.76–0.92) and 0.98 (0.85–0.99), respectively. The Bemelman guideline was thus a good predictor of SSRF in retrospective cohort but should be used in conjunction with clinical judgement. Further validation is indicated in a prospective study.

scholarly journals Efficacy and tolerability of fixed association of oxycodone and naloxone in elderly patients with ribs fracture: An 18-month retrospective study

2019 ◽  
Vol 15 (2) ◽  
Author(s):  
Alessandro Riccardi ◽  
Beatrice Spinola ◽  
Pierangela Minuto ◽  
Marco Licenziato ◽  
Valeria Ghiglione ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Elderly Patients ◽  
The Elderly ◽  
Pain Scale ◽  
Rib Fractures ◽  
Multiple Rib Fractures ◽  
Short And Long Term ◽  
Inflammatory Drugs ◽  
Better Than

Blunt chest trauma with isolated or multiple rib fractures constitutes a common presentation in Emergency Department (ED), particularly in elderly people. Rib fractures in the elderly create short- and long-term disabilities with a dramatic impact. Pain management in the elderly could be problematic due to non-steroidal anti-inflammatory drugs (NSAIDs) contraindication or interaction with other drugs. We performed this retrospective study collecting and retrieving all patients aged 65 or older, with a diagnosis of rib(s) fracture(s) during an 18-month period. We analyzed the different treatments chosen, and divided them into subgroups: oxycodone- naloxone, and other treatments (also divided in: codeineacetaminophen; NSAID or Acetaminophen; Tramadol or Tapentadol). A total of 475 elderly patients (aged 65 and older) with single or multiple rib fractures were evaluated in our ED in 18 months: of these 410 patients were considered eligible, with a mean age of 79.28 years (standard deviation 7.83). 185 were male and 225 were female. Our study confirms the efficacy and tolerability of fixed association of oxycodone and naloxone. This association determined the highest and fastest reduction on Numeric Pain Scale reported by patients and is significantly better than other drugs in oral administration.

scholarly journals Management of multiple rib fractures-results from a Major Trauma Centre with review of the existing literature

2020 ◽  
Author(s):  
Debkumar Chowdhury ◽  
P. Okoh ◽  
H. Dambappa
Keyword(s):  
Major Trauma ◽  
Significant Proportion ◽  
Fragility Fractures ◽  
Trauma Centre ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Analgesic Requirement ◽  
Multiple Rib Fractures ◽  
Major Trauma Centre ◽  
The Impact

Abstract Introduction Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. It accounts for more than 15% of ED presentations (1) on a global scale. As the population ages the incidence of rib fractures also rises often following falls from a relatively small height being part of fragility fractures. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.Aim To assess our current management of rib fractures at our trauma centreMethod We collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. We also studied the number of rib fracture stabilisation procedures and the average number of ribs fixed.Results The data was collected retrospectively over a period of 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.Conclusion The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

Multiple rib fractures: A novel and prognostic CT-based classification system

Trauma ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 265-272
Author(s):  
Rosalind B Simpson ◽  
Jessica R Dorman ◽  
William J Hunt ◽  
John G Edwards
Keyword(s):  
Clinical Outcomes ◽  
Classification System ◽  
Wide Spectrum ◽  
Flail Chest ◽  
Derived Categories ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Observer Agreement ◽  
Multiple Rib Fractures ◽  
The Impact

Background The accepted classification for multiple rib fractures is binary: flail chest or not. There is a wide spectrum of morphology with subsequent variation in the impact on chest wall mechanics and clinical outcomes. As the practice of surgical stabilisation of rib fractures evolves, there is a need for a better taxonomy. The aim of this study was to create a data-driven radiological classification system for multiple rib fractures, prognostic of both complications and surgical stabilisation of rib fracture. Methods The radiological pattern of injury was assessed for cases undergoing surgical stabilisation of rib fracture (n = 48) over a five-year period and a consecutive sample of non-operative controls (n = 48). Every rib fracture (n = 1032) was assessed on CT scans for location, displacement and comminution. An iterative classification system was developed and tested for inter-observer agreement and outcome prediction. Results The fractures occurred in a ‘series’ (≥3 consecutive ribs at a similar location) in 72% of cases: these were more likely to be displaced (p < 0.001). Variables included in the classification were the anatomical pattern (presence, length and overlap of series) and degree of displacement. The classification was prognostic for complications (p < 0.001), discriminated for fixation (C = 0.907) and had acceptable inter-observer agreement (k = 0.50). Conclusions The Sheffield Multiple Rib Fracture Classification derived categories of short/long series, and short/long flail chest, with sub-division according to the presence of displacement. It was prognostic for clinical outcomes and of surgical fixation. It may facilitate communication, comparison of outcomes and selection for management protocols.

scholarly journals Utilization of clinical autopsy services in a Nigerian teaching hospital

2020 ◽  
Vol 0 ◽  
pp. 1-5
Author(s):  
Samuel Robsam Ohayi ◽  
Anthony Jude Edeh ◽  
Nnaemeka Thaddeus Onyishi
Keyword(s):  
Internal Medicine ◽  
Quality Control ◽  
Retrospective Study ◽  
Associated Factors ◽  
Obstetrics And Gynecology ◽  
Education For All ◽  
Autopsy Rate ◽  
Average Hospital Stay ◽  
Average Hospital ◽  
Socioeconomic Strata

Objectives: The aim of this study was to ascertain the rate of uptake of clinical autopsy services in our hospital and also determine the associated factors. Autopsy is an important part of clinical practice. It serves as an audit and quality control for diagnosis and treatment of diseases. It also provides families with “informed grieving” by giving clearer understanding of the nature of illness and cause of death and may reveal inheritable or communicable diseases among other benefits. Despite these benefits, the rate of autopsy is low and declining globally. Material and Methods: A retrospective study of hospital autopsies performed from January 2013 to December 2017 was carried out. The mortuary and autopsy records of our hospital over the period were retrieved and reviewed. Deaths reported to the police, namely, coroner deaths and deaths before arriving at the hospital (brought in dead, BID) were excluded from the study. Results: A total of 1976 bodies was studied, 1078 males and 898 females (M:F = 1:1.2). Consent for autopsy was sought in 22 (1.1%) cases: 13 (0.66%) from pediatrics, 5 (0.25%) from internal medicine, and the rest from surgery and obstetrics and gynecology. Consent was granted and autopsy performed in 6 (0.3%) cases giving an average of 1.2 autopsies/year. Average hospital stay was 12.6 days and 36.3 days for those consenting to and those declining autopsy, respectively. Consenting persons belong to diverse socioeconomic strata. Conclusion: Autopsy rate is very low in our center. Attending clinicians and relatives of the deceased contribute to this trend. Vigorous education for all stakeholders about the benefits of hospital autopsy is recommended.

scholarly journals Les Perforations D’ulcere Gastro-Duodenal Au Centre National Hospitalier Et Universitaire (Cnhu) De Cotonou (Benin)

2016 ◽  
Vol 12 (27) ◽  
pp. 117
Author(s):  
Vignon Kc ◽  
Mehinto Dk ◽  
Vignon Kr ◽  
Mbele Rii ◽  
Natta N’tcha Nh ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Gastric Ulcer ◽  
Retrospective Study ◽  
Postoperative Complications ◽  
Gastric Perforation ◽  
Surgical Patients ◽  
Duodenal Perforation ◽  
Average Hospital Stay ◽  
Average Hospital ◽  
Generalized Peritonitis

Introduction: Duodenal or gastric ulcer perforations constitute a medical and surgical emergency. Purpose: Expose its epidemiological, diagnostic and therapeutic aspects. Method: About a retrospective study from January 1st 2006 to March 31st, 2012 in visceral surgery at CNHU of Cotonou, records of 86 cases of duodenal or gastric ulcer perforation were analyzed. Results: On average 13.8 cases / year, perforation of peptic ulcer was the most etiological cause of acute generalized peritonitis (25.7%). The average age was 34.2 years, the sex ratio of 16.2. Average admission stay was 6 days and it was observed: undocumented epigastralgia (42cas; 48.8%), no pathological medical history (32 cases; 37.2%). Peritoneal syndrome was in 81 cases (94.2%). Abdomen radiography without preparation (71 patients / 86; 82.6%) showed a pneumoperitoneum (52 cases / 71; 77.6%). The treatment was nonoperative (2 cases / 86; 2.3%) with a favorable outcome. Surgical patients had duodenal perforation (49 cases / 84; 57%), gastric perforation (35 cases / 84; 43%). Suturing with or without other technical devices was achieved in all cases. Postoperative complications were present in 28.5% of cases and parietal abscesses were documented as a priority (14 cases / 84; 16.7%). Mortality rate was 4.7% (4/86) and the average hospital stay was 11.6 days. Conclusion: The perforations of peptic ulcer were common in young men. Clinical examination was especially helpful in the diagnosis by abdomen radiography without preparation. The treatment was medical and surgical and the outcome was mostly favorable.

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