Introduction
Methods
Design and participants
Data collection and outcome measures
Statistical analysis
Results
Patients with a non-flail fracture pattern
All (n = 228) | SSRF (n = 25) | Nonoperative (n = 203) | p value | ||||
---|---|---|---|---|---|---|---|
Na | Na | Na | |||||
Patient characteristics | |||||||
Age (years) | 228 | 49 (35–63 | 25 | 50 (32–62) | 203 | 49 (35–64) | 0.797 |
BMI (kg/m2) | 194 | 25.8 (23.5–29.4) | 22 | 27.2 (24.3–29.7) | 172 | 25.9 (23.1–29.4) | 0.371 |
Sex (male) | 228 | 174 (76.3%) | 25 | 17 (68%) | 203 | 157 (77.3%) | 0.321 |
Smoking | 160 | 71 (44.4%) | 21 | 10 (48%) | 139 | 61 (43.9%) | 0.816 |
COPD | 228 | 10 (4.4%) | 25 | 0 (0%) | 203 | 10 (4.9%) | 0.607 |
Diabetes mellitus | 228 | 25 (11.0%) | 25 | 3 (12%) | 203 | 22 (10.8%) | 0.743 |
Injury characteristics | |||||||
Fractured ribs (N) | 228 | 7 (5–9) | 25 | 8 (7–12) | 203 | 6 (5–9) | 0.009 |
Bilateral rib fractures | 228 | 83 (36.4%) | 25 | 9 (36%) | 203 | 74 (36.5%) | 1.000 |
Fracture in every rib region | 194 | 34 (17.5%) | 20 | 5 (25%) | 174 | 29 (16.7%) | 0.356 |
≥ 100% displacement of ≥ 3 ribs | 223 | 159 (71.3%) | 24 | 21 (88%) | 199 | 138 (69.3%) | 0.092 |
Pneumothorax | 228 | 153 (67.1%) | 25 | 20 (80%) | 203 | 133 (65.5%) | 0.179 |
Hemothorax | 228 | 101 (44.5%) | 25 | 13 (52%) | 203 | 88 (43.6%) | 0.523 |
Pulmonary contusion | 228 | 165 (73.0%) | 25 | 21 (84%) | 203 | 144 (71.6%) | 0.237 |
ISS | 228 | 29 (25–38) | 25 | 29 (25–36) | 203 | 33 (26–41) | 0.502 |
Epidural hematoma | 228 | 23 (10.1%) | 25 | 3 (12%) | 203 | 20 (9.9%) | 0.725 |
Subdural hematoma | 228 | 127 (55.7%) | 25 | 9 (36%) | 203 | 118 (58.1%) | 0.053 |
Subarachnoid hemorrhage | 228 | 154 (67.5%) | 25 | 15 (60%) | 203 | 139 (68.5%) | 0.497 |
Diffuse axonal injury | 228 | 44 (19.3%) | 25 | 5 (20%) | 203 | 39 (19.2%) | 1.000 |
Intra-parenchymal hemorrhage | 228 | 76 (33.3%) | 25 | 12 (48%) | 203 | 64 (31.5%) | 0.117 |
Intraventricular hemorrhage | 228 | 16 (7.0%) | 25 | 1 (4%) | 203 | 15 (7.4%) | 1.000 |
Brain contusion | 228 | 18 (7.9%) | 25 | 4 (16%) | 203 | 14 (6.9%) | 0.119 |
Intracranial hypertension | 228 | 50 (22.4%) | 25 | 2 (8%) | 203 | 48 (24.2%) | 0.077 |
Severe TBI (GCS ≤ 8) | 228 | 177 (77.6%) | 25 | 14 (56%) | 203 | 163 (80.3%) | 0.010 |
Treatment characteristics | |||||||
Chest tube required | 228 | 134 (62.7%) | 25 | 22 (88%) | 203 | 121 (59.6%) | 0.004 |
ICP reducing therapy required | 228 | 87 (38.2%) | 25 | 4 (16%) | 203 | 83 (40.9%) | 0.016 |
Tracheostomy required | 228 | 88 (38.6%) | 25 | 10 (40%) | 203 | 78 (38.4%) | 1.000 |
Additional surgeries required | |||||||
Emergency thoracotomy | 228 | 6 (2.6%) | 25 | 1 (4%) | 203 | 5 (2.5%) | 0.506 |
Emergency laparotomy | 228 | 25 (11.0%) | 25 | 2 (8%) | 203 | 23 (11.3%) | 1.000 |
Pelvic surgery | 228 | 24 (10.5%) | 25 | 1 (4%) | 203 | 23 (11.3%) | 0.487 |
Long bone surgery | 228 | 48 (21.1%) | 25 | 4 (16%) | 203 | 44 (21.7%) | 0.612 |
Spine surgery | 228 | 29 (12.7%) | 25 | 2 (8%) | 203 | 27 (13.3%) | 0.750 |
Outcome characteristics | |||||||
Mechanical ventilation (days) | 228 | 10 (4–18) | 25 | 8 (4–19) | 203 | 10 (4–18) | 0.802 |
Ventilator-free days (days) | 228 | 10 (2–21) | 25 | 9 (7–17) | 203 | 11 (1–23) | 0.815 |
Motor GCS score recovery to 6 | 214 | 172 (80.4%) | 23 | 23 (100%) | 191 | 149 (78.0%) | 0.010 |
Time to motor GCS 6 (days) | 162 | 3 (1–11) | 22 | 2 (1–6) | 140 | 4 (1–14) | 0.045 |
Pneumonia | 228 | 102 (44.7%) | 25 | 6 (24%) | 203 | 96 (47.3%) | 0.033 |
Pleural empyema | 228 | 4 (1.8%) | 25 | 0 (0%) | 203 | 4 (2%) | 1.000 |
ICU LOS | 228 | 13 (6–21) | 25 | 12 (7–20) | 203 | 13 (6–21) | 0.921 |
HLOS | 228 | 21 (13–39) | 25 | 21 (14–28) | 203 | 21 (13–40) | 0.681 |
30-day mortality | 228 | 36 (15.8%) | 25 | 0 (0%) | 203 | 36 (17.7%) | 0.018 |
In-hospital mortality | 228 | 40 (17.5%) | 25 | 1 (4%) | 203 | 39 (19.2%) | 0.090 |
Mortality cause | |||||||
Traumatic brain injury | 31 | 13 (42%) | 1 | 0 (0%) | 30 | 13 (43%) | 0.366 |
Pulmonary origin | 31 | 5 (16%) | 1 | 0 (0%) | 30 | 5 (17%) | |
Septic shock | 31 | 6 (19%) | 1 | 0 (0%) | 30 | 6 (20%) | |
Hemorrhagic shock | 31 | 0 (0%) | 1 | 0 (0%) | 30 | 0 (0%) | |
Cardiac origin | 31 | 1 (3%) | 1 | 0 (0%) | 30 | 1 (3%) | |
Withdrawal of care | 31 | 6 (19%) | 1 | 1 (17%) | 30 | 5 (17%) |
Outcome | Multivariable analysis | |||||
---|---|---|---|---|---|---|
Crude analysis | Adjusted analysis | |||||
Na | Beta or OR (95% CI) | p value | Na | Beta or OR (95% CI) | p value | |
Ventilator-free days | 228 | − 4.09 (− 12.27 to 4.10) | 0.326 | 228 | − 5.91 (− 14.39 to 2.58) | 0.171 |
ICU LOS | 228 | − 1.24 (− 6.13 to 3.65) | 0.618 | 228 | − 2.85 (− 7.82 to 2.12) | 0.260 |
HLOS | 228 | − 5.32 (− 14.96 to 4.31) | 0.278 | 228 | − 8.62 (− 18.55 to 1.31) | 0.089 |
Pneumonia | 228 | 0.35 (0.14 to 0.92) | 0.033 | 228 | 0.29 (0.11 to 0.77) | 0.013 |
Motor GCS score recovery to 6 | 214 | ND | ND | 214 | ND | ND |
In-hospital mortality | 228 | 0.18 (0.02 to 1.34) | 0.093 | 228 | 0.24 (0.03 to 1.90) | 0.176 |
30-day mortality | 228 | ND | ND | 228 | ND | ND |
Patients with a flail chest
All (n = 221) | SSRF (n = 86) | Nonoperative (n = 135) | p value | ||||
---|---|---|---|---|---|---|---|
Na | Na | Na | |||||
Patient characteristics | |||||||
Age (years) | 221 | 51 (40–62) | 86 | 49 (38–60) | 135 | 51 (42–62) | 0.508 |
BMI (kg/m2) | 189 | 27.1 (23.9–31.3) | 78 | 27.8 (24.6–32.6) | 120 | 26.3 (23.5–30.0) | 0.057 |
Sex (male) | 220 | 168 (76.4%) | 85 | 63 (74%) | 135 | 105 (77.8%) | 0.625 |
Smoking | 163 | 59 (36.2%) | 101 | 28 (45%) | 62 | 31 (30.7%) | 0.067 |
COPD | 221 | 16 (7.2%) | 86 | 11 (13%) | 135 | 5 (3.7%) | 0.016 |
Diabetes mellitus | 221 | 23 (10.4%) | 86 | 11 (13%) | 135 | 12 (8.9%) | 0.373 |
Injury characteristics | |||||||
Fractured ribs (N) | 221 | 9 (8–12) | 86 | 9 (8–12) | 135 | 9 (7–12) | 0.855 |
Bilateral rib fractures | 221 | 100 (45.2%) | 86 | 35 (41%) | 135 | 65 (48.1%) | 0.332 |
Fracture in every rib region | 207 | 104 (50.2%) | 80 | 43 (54%) | 127 | 61 (48.0%) | 0.476 |
≥ 100% displacement of ≥ 3 ribs | 214 | 138 (64.5%) | 85 | 60 (71%) | 129 | 78 (60.5%) | 0.146 |
Pneumothorax | 221 | 186 (84.2%) | 86 | 74 (86%) | 135 | 112 (83.0%) | 0.577 |
Hemothorax | 220 | 140 (63.6%) | 85 | 54 (64%) | 135 | 86 (63.7%) | 1.000 |
Pulmonary contusion | 219 | 165 (75.3%) | 86 | 64 (74%) | 133 | 101 (75.9%) | 0.873 |
ISS | 221 | 34 (29–44) | 86 | 34 (29–43) | 135 | 36 (29–45) | 0.235 |
Epidural hematoma | 221 | 15 (6.8%) | 86 | 3 (3%) | 135 | 12 (8.9%) | 0.171 |
Subdural hematoma | 221 | 110 (49.8%) | 86 | 32 (37%) | 135 | 78 (57.8%) | 0.004 |
Subarachnoid hemorrhage | 221 | 141 (63.8%) | 86 | 45 (52%) | 135 | 96 (71.1%) | 0.006 |
Diffuse axonal injury | 221 | 43 (19.5%) | 86 | 16 (19%) | 135 | 27 (20.0%) | 0.863 |
Intra-parenchymal hemorrhage | 221 | 55 (24.9%) | 86 | 22 (26%) | 135 | 33 (24.4%) | 0.874 |
Intraventricular hemorrhage | 221 | 24 (10.9%) | 86 | 4 (5%) | 135 | 20 (14.8%) | 0.025 |
Brain contusion | 221 | 50 (22.6%) | 86 | 22 (26%) | 135 | 28 (20.7%) | 0.414 |
Intracranial hypertension | 221 | 48 (22.1%) | 86 | 10 (12%) | 135 | 38 (29.0%) | 0.003 |
Severe TBI (GCS ≤ 8) | 221 | 178 (80.5%) | 86 | 62 (72%) | 135 | 116 (85.9%) | 0.015 |
Treatment characteristics | |||||||
Chest tube required | 221 | 180 (81.4%) | 86 | 77 (90%) | 135 | 103 (76.3%) | 0.014 |
ICP reducing therapy required | 221 | 81 (36.7%) | 86 | 22 (26%) | 135 | 59 (43.7%) | 0.007 |
Tracheostomy required | 221 | 81 (36.7%) | 86 | 25 (29%) | 135 | 56 (41.5%) | 0.065 |
Additional surgeries required | |||||||
Emergency thoracotomy | 221 | 12 (5.4%) | 86 | 7 (8%) | 135 | 5 (3.7%) | 0.223 |
Emergency laparotomy | 221 | 29 (13.1%) | 86 | 9 (11%) | 135 | 20 (14.8%) | 0.417 |
Pelvic surgery | 221 | 22 (10.0%) | 86 | 10 (12%) | 135 | 12 (8.9%) | 0.501 |
Long bone surgery | 221 | 58 (26.2%) | 86 | 29 (34%) | 135 | 29 (21.5%) | 0.059 |
Spine surgery | 221 | 17 (7.7%) | 86 | 4 (5%) | 135 | 13 (9.6%) | 0.205 |
Outcome characteristics | |||||||
Mechanical ventilation (days) | 221 | 10 (5–18) | 86 | 9 (5–14) | 135 | 11 (5–21) | 0.040 |
Ventilator-free days (days) | 221 | 11 (4–21) | 86 | 13 (8–20) | 135 | 9 (1–21) | 0.034 |
Motor GCS score recovery to 6 | 206 | 161 (78.2%) | 80 | 73 (91%) | 126 | 88 (69.8%) | < 0.001 |
Time to motor GCS 6 (days) | 144 | 4 (2–11) | 69 | 4 (1–9) | 75 | 5 (2–14) | 0.075 |
Pneumonia | 221 | 98 (44.3%) | 86 | 32 (37%) | 135 | 66 (48.9%) | 0.097 |
Pleural empyema | 221 | 2 (0.9%) | 86 | 1 (1%) | 135 | 1 (0.7%) | 1.000 |
ICU LOS | 221 | 14 (7–21) | 86 | 12 (7–17) | 135 | 15 (7–23) | 0.066 |
HLOS | 221 | 22 (14–34) | 86 | 22 (16–33) | 135 | 23 (11–35) | 0.914 |
30-day mortality | 221 | 33 (14.9%) | 86 | 7 (8%) | 135 | 26 (19.3%) | 0.032 |
In-hospital mortality | 221 | 34 (15.4%) | 86 | 7 (8%) | 135 | 27 (20.0%) | 0.021 |
Mortality cause | |||||||
Traumatic brain injury | 28 | 13 (46%) | 7 | 2 (29%) | 21 | 11 (52%) | 0.191 |
Pulmonary origin | 28 | 6 (21%) | 7 | 1 (14%) | 21 | 5 (24%) | |
Septic shock | 28 | 3 (11%) | 7 | 2 (29%) | 21 | 1 (5%) | |
Hemorrhagic shock | 28 | 1 (4%) | 7 | 1 (14%) | 21 | 0 (0%) | |
Cardiac origin | 28 | 3 (11%) | 7 | 1 (14%) | 21 | 2 (10%) | |
Withdrawal of care | 28 | 1 (4%) | 7 | 0 (0%) | 21 | 2 (10%) |
Outcome | Multivariable analysis | |||||
---|---|---|---|---|---|---|
Crude analysis | Adjusted analysis | |||||
Na | Beta or OR (95% CI) | p value | Na | Beta or OR (95% CI) | p value | |
Ventilator-free days | 221 | 1.25 (− 2.85 to 5.35) | 0.547 | 221 | − 0.28 (− 4.91 to 4.35) | 0.905 |
ICU LOS | 221 | − 2.72 (− 5.21 to − 0.23) | 0.033 | 221 | − 2.96 (− 5.70 to − 0.23) | 0.034 |
HLOS | 221 | − 1.76 (− 6.82 to 3.30) | 0.494 | 221 | − 3.36 (− 8.97 to 2.26) | 0.240 |
Pneumonia | 221 | 0.62 (0.36 to 1.08) | 0.089 | 221 | 0.75 (0.39 to 1.43) | 0.382 |
Motor GCS score recovery to 6 | 206 | 4.50 (1.90 to 10.68) | 0.001 | 206 | 3.98 (1.40 to 11.33) | 0.010 |
In-hospital mortality | 221 | 0.35 (0.15 to 0.86) | 0.021 | 221 | 0.39 (0.12 to 1.26) | 0.114 |
30-day mortality | 221 | 0.37 (0.15 to 0.90) | 0.028 | 221 | 0.40 (0.12 to 1.29) | 0.126 |