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Related Experiment Videos

Half-a-dozen ribs: the breakpoint for mortality.

Benjamin T Flagel1, Fred A Luchette, R Lawrence Reed

  • 1Division of Trauma, Critical Care, and Burns, Department of Surgery, Burn Shock Trauma Institute, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA.

Surgery
|November 5, 2005
PubMed
Summary

The number of rib fractures directly correlates with increased pulmonary complications and mortality. Patients with 6 or more rib fractures face significant mortality risks, and epidural analgesia may reduce deaths but is underused.

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Area of Science:

  • Trauma surgery
  • Critical care medicine
  • Pulmonary medicine

Background:

  • The impact of the number of rib fractures on patient outcomes was hypothesized to be significant.
  • Previous research has not fully elucidated the independent effect of rib fracture count on pulmonary morbidity and mortality.

Purpose of the Study:

  • To determine if the number of rib fractures independently impacts patient pulmonary morbidity and mortality.
  • To investigate the association between the number of rib fractures and various complications, including pneumonia, ARDS, and mortality.

Main Methods:

  • Utilized the National Trauma Data Bank (NTDB) to identify patients with one or more rib fractures.
  • Abstracted data on fracture count, injury severity, pulmonary complications, mechanical ventilation, length of stay, mortality, and epidural analgesia use.

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  • Performed statistical analysis using Student t-tests and linear regression, with P < .05 considered significant.

    • Main Results:

    • Of 731,823 patients, 9% had rib fractures; 13% of these developed complications, primarily chest-wall related.
    • Mechanical ventilation was required in 60% of patients, with an average of 13 ventilator days.
    • Mortality increased with each additional rib fracture (P < .02), as did pneumonia, ARDS, pneumothorax, aspiration pneumonia, empyema, and ICU/hospital LOS up to 7 fractures.

    Conclusions:

    • Increasing rib fractures directly correlate with higher pulmonary morbidity and mortality.
    • Patients with 6+ rib fractures face substantial mortality risks, even from non-rib-fracture causes.
    • Epidural analgesia showed a mortality reduction, particularly for >4 fractures, but its use is limited.