1
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Drayton KD, Mahajan A, Gates JD, Worth JM, Aitcheson EM, Ricaurte D. Subclavian vein injury secondary to blunt chest wall injury. Trauma Surg Acute Care Open 2024; 9:e001426. [PMID: 38737813 PMCID: PMC11086424 DOI: 10.1136/tsaco-2024-001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Affiliation(s)
- Ka'la D Drayton
- Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Aviral Mahajan
- School of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Jonathan D Gates
- School of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
- Surgery, Hartford Hospital, Hartford, Connecticut, USA
| | - Jennifer M Worth
- School of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
- Surgery, Hartford Hospital, Hartford, Connecticut, USA
| | - Elizabeth M Aitcheson
- School of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
- Surgery, Hartford Hospital, Hartford, Connecticut, USA
| | - Daniel Ricaurte
- School of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
- Surgery, Hartford Hospital, Hartford, Connecticut, USA
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2
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Cheng CT, Kuo LW, Ouyang CH, Hsu CP, Lin WC, Fu CY, Kang SC, Liao CH. Development and evaluation of a deep learning-based model for simultaneous detection and localization of rib and clavicle fractures in trauma patients' chest radiographs. Trauma Surg Acute Care Open 2024; 9:e001300. [PMID: 38646620 PMCID: PMC11029226 DOI: 10.1136/tsaco-2023-001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Purpose To develop a rib and clavicle fracture detection model for chest radiographs in trauma patients using a deep learning (DL) algorithm. Materials and methods We retrospectively collected 56 145 chest X-rays (CXRs) from trauma patients in a trauma center between August 2008 and December 2016. A rib/clavicle fracture detection DL algorithm was trained using this data set with 991 (1.8%) images labeled by experts with fracture site locations. The algorithm was tested on independently collected 300 CXRs in 2017. An external test set was also collected from hospitalized trauma patients in a regional hospital for evaluation. The receiver operating characteristic curve with area under the curve (AUC), accuracy, sensitivity, specificity, precision, and negative predictive value of the model on each test set was evaluated. The prediction probability on the images was visualized as heatmaps. Results The trained DL model achieved an AUC of 0.912 (95% CI 87.8 to 94.7) on the independent test set. The accuracy, sensitivity, and specificity on the given cut-off value are 83.7, 86.8, and 80.4, respectively. On the external test set, the model had a sensitivity of 88.0 and an accuracy of 72.5. While the model exhibited a slight decrease in accuracy on the external test set, it maintained its sensitivity in detecting fractures. Conclusion The algorithm detects rib and clavicle fractures concomitantly in the CXR of trauma patients with high accuracy in locating lesions through heatmap visualization.
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Affiliation(s)
- Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Chun-Hsiang Ouyang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Chi-Po Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Wei-Cheng Lin
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Shih-Ching Kang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan
- Department of medicine, Chang Gung university, Taoyuan, Taiwan
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3
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Villarreal JA, Forrester JD. Eyes on the prize: harnessing computer vision for automated detection of traumatic rib and clavicle fractures in chest radiographs. Trauma Surg Acute Care Open 2024; 9:e001455. [PMID: 38646616 PMCID: PMC11029340 DOI: 10.1136/tsaco-2024-001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Affiliation(s)
- Joshua Aaron Villarreal
- Department of Surgery, Stanford University Department of Medicine, Stanford, California, USA
| | - Joseph D Forrester
- Department of Surgery, Stanford University Department of Medicine, Stanford, California, USA
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4
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Shillinglaw JP, Nonnemacher CJ, Christie DB. Large Penetrating Wounds to the Chest Managed With Immediate Chest Wall Reconstruction Using Biologic Mesh, Titanium Plates, and Rotational Tissue Flaps. Am Surg 2024:31348241244649. [PMID: 38596898 DOI: 10.1177/00031348241244649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Large open chest wall wounds can be difficult to manage due to full-thickness tissue loss with underlying rib fractures and exposed lung parenchyma. Historically, the use of synthetic material has been discouraged in the traumatic setting with the concern that it may be associated with an increased risk of infection. We present 4 patients with large open injuries to the thorax-one from blunt and three from penetrating trauma. We describe our initial management followed by prompt surgical repair using biologic mesh, titanium rib spanning plates, and rotational tissue flaps with Z-plasty of the skin for definite closure. All patients did well post-operatively without complications or wound infections. With the appropriate management, we suspect there may be an advantage in performing immediate reconstruction and closure in large open thoracic injuries utilizing biologic mesh and titanium rib spanning plates with a lower risk of infection than previously believed.
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Affiliation(s)
- John P Shillinglaw
- Department of General Surgery and Trauma, Medical Center Atrium Health, Macon, GA, USA
| | - Cory J Nonnemacher
- Department of General Surgery and Trauma, Medical Center Atrium Health, Macon, GA, USA
| | - Dudley B Christie
- Department of General Surgery and Trauma, Medical Center Atrium Health, Macon, GA, USA
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5
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Eickholtz A, Mormol J, Kelley J, Mangione M, Pounders S, Groseclose R, Lypka M, Gibson C, Chapman A, Chadwick C, Krech L. The Effect of COVID-19 on Rib Fracture Patients in Michigan. Am Surg 2024:31348241241634. [PMID: 38565216 DOI: 10.1177/00031348241241634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This study aims to compare outcomes of rib fracture patients with and without COVID-19 in Michigan. Data from the Michigan Trauma Quality Improvement Program (MTQIP) identified adults hospitalized from January 1, 2020, to October 31, 2022, with at least one rib fracture and a completed COVID-19 test on admission. Patients were propensity score matched 1:1 using 20 variables. The primary outcome was hospital length of stay (LOS). Secondary outcomes were mortality, ventilator days, intensive care unit (ICU) LOS, pneumonia, and ventilator-assisted pneumonia (VAP). 13,305 total patients were identified. 232 patients matched into both the COVID+ and COVID- groups. COVID was associated with increased LOS (7 days vs. 5 days, P < 0.001). There were no significant differences between the two groups when evaluating secondary outcomes. Our study indicates that although COVID-19 infection is associated with increased LOS, COVID may not contribute to additional morbidity or mortality in traumatic rib fracture patients.
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Affiliation(s)
- Allie Eickholtz
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Jeremy Mormol
- Trauma Research Institute, Corewell Health West, Grand Rapids, MI, USA
| | - Jesse Kelley
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Madi Mangione
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Steffen Pounders
- Trauma Research Institute, Corewell Health West, Grand Rapids, MI, USA
| | - Ryan Groseclose
- Trauma Research Institute, Corewell Health West, Grand Rapids, MI, USA
| | - Matthew Lypka
- Scholarly Activity and Scientific Support, Corewell Health, Grand Rapids, MI, USA
| | - Charles Gibson
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Alistair Chapman
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Cathryn Chadwick
- Department of Acute Care Surgery, Corewell Health West, Grand Rapids, MI, USA
| | - Laura Krech
- Trauma Research Institute, Corewell Health West, Grand Rapids, MI, USA
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6
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Wang D, Wang X, Wang Q, Xu Y, Xu Y. Comparative study of wound outcomes and surgical strategies: Internal fixation versus external stabilization in rib fracture patients with traumatic chest wounds. Int Wound J 2024; 21:e14548. [PMID: 38151911 PMCID: PMC10961044 DOI: 10.1111/iwj.14548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 12/29/2023] Open
Abstract
The clinical management of traumatic chest incisions accompanied by rib fractures presents the formidable challenge. The study was carried out to compare the outcomes of auscultatory triangle internal fixation (ATIF) and external fixation (EF) in such injuries. From June 2019 to June 2022, 105 patients with multiple rib fractures participated in the cohort study in which they were divided into two groups: 53 patients underwent ATIF and 52 patients underwent EF. The incidence of surgical site infection, wound healing time, incidence of wound dehiscence, number of dressing changes, pain as measured by the visual analogue scale (VAS), duration of hospitalization, period of return to work, pulmonary complications and functionality of the upper limbs as assessed by the Disability of Arm, Shoulder, and Hand (DASH) questionnaire were among the parameters evaluated. In comparison with EF, ATIF demonstrated the decreased incidence of wound dehiscence (1.9% vs. 9.6%) (p < 0.05), surgical site infection (3.8 vs. 11.5) and wound healing time (12.3 ± 2.1 vs. 18.5 ± 3.7 days) (p < 0.05). Furthermore, during their ATIF treatment, patients required fewer changes of dressing (3.5 ± 0.8 vs. 5.7 ± 1.2) and demonstrated enhanced pain management, reduced hospital stays and expedited return to work (p < 0.05). ATIF group demonstrated enhancements in both upper limb functionality and post-operative pulmonary function (p < 0.05). The utilization of ATIF as opposed to EF for the treatment of traumatic chest wounds accompanied by rib fractures yields superior outcomes in terms of wound healing, infection reduction and restoration of pulmonary and upper limb functionality.
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Affiliation(s)
- Dongdong Wang
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Xiaoqi Wang
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Qingqing Wang
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Yueping Xu
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Yongdong Xu
- Department of Thoracic Surgery, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
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7
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Alqazzaz A, Naseer Z, Beyer CA, Cannon JW, Khalsa A. Treatment approach for coexisting chest wall fractures and unstable thoracolumbar spine fractures in polytrauma patients requiring prone spine surgery. Trauma Surg Acute Care Open 2024; 9:e001196. [PMID: 38529315 PMCID: PMC10961491 DOI: 10.1136/tsaco-2023-001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/31/2023] [Indexed: 03/27/2024] Open
Abstract
Concomitant chest wall fractures (sternal and/or rib fractures) with unstable thoracolumbar fractures that require surgical fixation are rare but highly morbid injuries that mandate a multidisciplinary approach to treatment. There is limited evidence in the literature regarding optimal timing and order of surgical fixation of these patients with multiple injuries. Here, we present our experience with two patients at a single institution that demonstrates the challenges that present with this patient population. We advocate for earlier fixation of the chest wall fractures in the appropriately indicated patients, prior to prone positioning for spinal fixation.
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Affiliation(s)
- Aymen Alqazzaz
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zan Naseer
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Carl A Beyer
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Amrit Khalsa
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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8
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Smith SA, Hilsden R, Patton P, Vogt K, Beckett A, Ball IM. Management of Rib Fractures in the Combat Environment. J Spec Oper Med 2024:FTLJ-MQXX. [PMID: 38457121 DOI: 10.55460/ftlj-mqxx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Rib fractures in combat casualties are an under-appreciated injury, and their treatment may become more common as more patients survive because of modern body armor and point-ofinjury care. The combat environment has challenges such as equipment availability and sterility. A simple and thoughtful rib fracture treatment algorithm may be useful to reduce the morbidity and mortality of rib fractures in the combat environment. Intravenous lidocaine infusions for patients with traumatic rib fractures may have important combat applications. We propose an algorithm for the management of combat casualties with traumatic rib fractures.
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9
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Van Wijck SFM, Barza A, Vermeulen J, Eyck BM, Van der Wilk BJ, Van der Harst E, Verhofstad MHJ, Lagarde SM, Van Lieshout EMM, Wijffels MME. Fractures and other chest wall abnormalities after thoracotomy for esophageal cancer: A retrospective cohort study. World J Surg 2024; 48:662-672. [PMID: 38305774 DOI: 10.1002/wjs.12083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Chest pain following a thoracotomy for esophageal cancer is frequently reported but poorly understood. This study aimed to (1) determine the prevalence of thoracotomy-related thoracic fractures on postoperative imaging and (2) compare complications, long-term pain, and quality of life in patients with versus without these fractures. METHODS This retrospective cohort study enrolled patients with esophageal cancer who underwent a thoracotomy between 2010 and 2020 with pre- and postoperative CTs (<1 and/or >6 months). Disease-free patients were invited for questionnaires on pain and quality of life. RESULTS Of a total of 366 patients, thoracotomy-related rib fractures were seen in 144 (39%) and thoracic transverse process fractures in 4 (2%) patients. Patients with thoracic fractures more often developed complications (89% vs. 74%, p = 0.002), especially pneumonia (51% vs. 39%, p = 0.032). Questionnaires were completed by 77 after a median of 41 (P25 -P75 28-91) months. Long-term pain was frequently (63%) reported but was not associated with thoracic fractures (p = 0.637), and neither were quality of life scores. CONCLUSIONS Thoracic fractures are prevalent in patients following a thoracotomy for esophageal cancer. These thoracic fractures were associated with an increased risk of postoperative complications, especially pneumonia, but an association with long-term pain or reduced quality of life was not confirmed.
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Affiliation(s)
- Suzanne F M Van Wijck
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Athiná Barza
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jefrey Vermeulen
- Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Ben M Eyck
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Berend J Van der Wilk
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mathieu M E Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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10
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Naeem S, Aziz S, Carballido F, Leung J. Improving the Diagnosis of Rib Fractures in the Emergency Department: A Quality Improvement Project in a District General Hospital in the United Kingdom. Cureus 2024; 16:e56873. [PMID: 38659561 PMCID: PMC11040407 DOI: 10.7759/cureus.56873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Background Falls in older people are a common presentation in emergency departments (ED) in the United Kingdom. They can lead to multiple injuries, including chest wall injuries (CWIs). Untreated CWI carries significant morbidity and mortality. However, its diagnosis remains challenging during the initial ED encounter. This led to a quality improvement project (QIP) to improve the diagnosis of CWI in patients presenting to William Harvey Hospital, a district general, trauma-unit ED in Willesborough, England. Methods The QIP was run from February 2020 to April 2021 for 14 months. A series of plan-do-study-act (PDSA) cycles were completed to increase the proportion of CWIs diagnosed during the initial ED encounter to 90%. The primary interventions involved designing a new thoracic trauma proforma and the introduction of the modified pain, inspiratory effort, and cough (PIC) score to evaluate and triage patients with CWI. Other interventions included the delivery of an education programme on CWI. The secondary aims were to increase modified PIC score use and to reduce the time between ED presentation and computerised tomography (CT) scanning. Results A total of 147 patients were included in three PDSA cycles. The diagnosis of CWI during the initial ED encounter increased from 61% at baseline to 91%. The median time from ED attendance to the first CT reduced from 477 minutes to 169 minutes. Lastly, following the introduction of the thoracic trauma proforma, the modified PIC score was used in 26% of cases of CWI by the end of the QIP period. Conclusion Our QIP led to improvement in the early diagnosis of CWIs in ED, with significant improvements in door to CT time and the creation of a thoracic injury pathway in the trust leading to multi-specialty improvement of care of such patients.
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Affiliation(s)
- Salman Naeem
- Emergency Medicine, East Kent Hospitals University NHS Foundation Trust, Ashford, GBR
| | - Shadman Aziz
- Emergency Medicine, Barts Health NHS Trust, London, GBR
- Prehospital Emergency Medicine, East Anglian Air Ambulance, Norwich, GBR
| | - Fernando Carballido
- Emergency Medicine, East Kent Hospitals University NHS Foundation Trust, Ashford, GBR
| | - Jonathan Leung
- Emergency Medicine, East Kent Hospitals University NHS Foundation Trust, Ashford, GBR
- Prehospital Emergency Medicine, Air Ambulance Kent, Surrey and Sussex, Redhill, GBR
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11
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Grimes AD, Stettler GR, Nunn AM. Immediate chest wall stabilization following thoracotomy for hemorrhage in severe blunt thoracic trauma. Trauma Surg Acute Care Open 2024; 9:e001394. [PMID: 38420605 PMCID: PMC10900399 DOI: 10.1136/tsaco-2024-001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Arthur Dinkins Grimes
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gregory R Stettler
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew M Nunn
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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12
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Mohseni S, Forssten MP, Mohammad Ismail A, Cao Y, Hildebrand F, Sarani B, Ribeiro MAF. Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures. Trauma Surg Acute Care Open 2024; 9:e001206. [PMID: 38347893 PMCID: PMC10860062 DOI: 10.1136/tsaco-2023-001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Studies have shown an increased risk of morbidity in elderly patients suffering rib fractures from blunt trauma. The association between frailty and rib fractures on adverse outcomes is still ill-defined. In the current investigation, we sought to delineate the association between frailty, measured using the Orthopedic Frailty Score (OFS), and outcomes in geriatric patients with isolated rib fractures. Methods All geriatric (aged 65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement database with a conservatively managed isolated rib fracture were considered for inclusion. An isolated rib fracture was defined as the presence of ≥1 rib fracture, a thorax Abbreviated Injury Scale (AIS) between 1 and 5, an AIS ≤1 in all other regions, as well as the absence of pneumothorax, hemothorax, or pulmonary contusion. Based on patients' OFS, patients were classified as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The prevalence ratio (PR) of composite complications, in-hospital mortality, failure-to-rescue (FTR), and intensive care unit (ICU) admission between the OFS groups was determined using Poisson regression models to adjust for potential confounding. Results A total of 65 375 patients met the study's inclusion criteria of whom 60% were non-frail, 29% were pre-frail, and 11% were frail. There was a stepwise increased risk of complications, in-hospital mortality, and FTR from non-frail to pre-frail and frail. Compared with non-frail patients, frail patients exhibited a 87% increased risk of in-hospital mortality [adjusted PR (95% CI): 1.87 (1.52-2.31), p<0.001], a 44% increased risk of complications [adjusted PR (95% CI): 1.44 (1.23-1.67), p<0.001], a doubling in the risk of FTR [adjusted PR (95% CI): 2.08 (1.45-2.98), p<0.001], and a 17% increased risk of ICU admission [adjusted PR (95% CI): 1.17 (1.11-1.23), p<0.001]. Conclusion There is a strong association between frailty, measured using the OFS, and adverse outcomes in geriatric patients managed conservatively for rib fractures.
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Affiliation(s)
- Shahin Mohseni
- Orebro universitet Fakulteten for medicin och halsa, Orebro, Sweden
- Department of Surgery, Sheikh Shakhbout Medical City—Mayo Clinic, Abu Dhabi, UAE
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Babak Sarani
- George Washington University, Washington, District of Columbia, USA
| | - Marcelo AF Ribeiro
- Department of Surgery, Sheikh Shakhbout Medical City—Mayo Clinic, Abu Dhabi, UAE
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13
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Sarani B. Comparison of postoperative pain in surgical stabilization of rib fracture technique: intrathoracic plates versus extrathoracic plates. Trauma Surg Acute Care Open 2024; 9:e001321. [PMID: 38274023 PMCID: PMC10806493 DOI: 10.1136/tsaco-2023-001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Babak Sarani
- Surgery, George Washington University, Washington, District of Columbia, USA
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14
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Özdülger A. Thoracic trauma in children. Turk Gogus Kalp Damar Cerrahisi Derg 2024; 32:S21-S28. [PMID: 38584786 PMCID: PMC10995687 DOI: 10.5606/tgkdc.dergisi.2024.25746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 04/09/2024]
Abstract
Isolated thoracic trauma is rare in children. Because of their small body size, the trauma often also affects other spaces, such as the abdomen and head, and these coexistences significantly increase the rate of mortality. However, in isolated thoracic traumas, the children can quickly recover if they can survive the initial period of trauma. Pediatric thoracic trauma cases can have a different clinical course compared to adults due to the unique anatomic and physiologic properties of children's thoracic cages. Their ribs are nonossified and are very elastic, and therefore, as their ribs can sustain significant deformation without breaking, some significant intrathoracic injuries can be overlooked. In this review, the most common thoracic injuries, including pulmonary contusion, hemopneumothorax, pulmonary laceration, rib fractures, flail chest, tracheobronchial injuries, traumatic asphyxia, and other less common mediastinal injuries are discussed in detail in regard of clinical presentation and management.
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Affiliation(s)
- Ali Özdülger
- Department of Thoracic Surgery, Mersin University Faculty of Medicine, Mersin, Türkiye
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15
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Mohamed EH, Elmoheen A, Bashir K, Fayed M, Abdurabu M, Abdelrahim MG, Elkandow A, Basharat K, Lloyd S, Alwahsh G, Zaki HA. Comparative Analysis of Intravenous Opioids Versus Thoracic Epidural Anesthesia in Fractured Rib Pain Management: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e51740. [PMID: 38318591 PMCID: PMC10840374 DOI: 10.7759/cureus.51740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/07/2024] Open
Abstract
Rib fractures, common among trauma victims, lead to significant morbidity and mortality. Managing the associated pain is challenging, with IV opioids and thoracic epidural analgesia (TEA) being utilized. While epidural analgesia is often preferred for fractured rib pain, existing data encompasses both lumbar and thoracic approaches. This review aimed to compare TEA and IV opioids for persistent rib fracture pain. A comprehensive search across five databases yielded 987 articles, of which seven met the eligibility criteria. Outcomes were categorized into primary (pain reduction) and secondary (mortality, hospital/ICU stays, analgesia-related complications) endpoints. Analyzed with Review Manager (RevMan) Version 5.4.1 (2020; The Cochrane Collaboration, London, United Kingdom), the pooled data from two sources showed TEA significantly more effective in reducing pain than IV opioids (standardized mean difference (SMD): 2.23; 95%CI: 1.65-2.82; p < 0.00001). Similarly, TEA was associated with shorter ICU stays (SMD: 0.73; 95%CI: 0.33-1.13; p = 0.0004), while hospitalization duration showed no substantial difference (SMD: 0.82; 95%CI: -0.34-1.98). Mortality rates also did not significantly differ between TEA and IV opioids (risk ratio (RR): 1.20; 95%CI: 0.36-4.01; p = 0.77). Subgroup analysis revealed fewer pneumonia cases with TEA (RR: 2.06; 95%CI: 1.07-3.96; P = 0.03), with no notable disparities in other complications. While TEA's superiority in pain relief for rib fractures suggests it is the preferred analgesic, the recommendation's strength is tempered by the low methodological quality of supporting articles.
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Affiliation(s)
| | - Amr Elmoheen
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Khalid Bashir
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
- Emergency Medicine, Qatar University College of Medicine, Doha, QAT
| | - Mohamed Fayed
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | - Ali Elkandow
- Emergency Medicine, Hamad Medical Corporation, Al Khor, QAT
| | | | - Stuart Lloyd
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | - Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
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Bhatia BS, Morlese JF, Yusuf S, Xie Y, Schallhorn B, Gruen D. A real-world evaluation of the diagnostic accuracy of radiologists using positive predictive values verified from deep learning and natural language processing chest algorithms deployed retrospectively. BJR Open 2024; 6:tzad009. [PMID: 38352188 PMCID: PMC10860529 DOI: 10.1093/bjro/tzad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives This diagnostic study assessed the accuracy of radiologists retrospectively, using the deep learning and natural language processing chest algorithms implemented in Clinical Review version 3.2 for: pneumothorax, rib fractures in digital chest X-ray radiographs (CXR); aortic aneurysm, pulmonary nodules, emphysema, and pulmonary embolism in CT images. Methods The study design was double-blind (artificial intelligence [AI] algorithms and humans), retrospective, non-interventional, and at a single NHS Trust. Adult patients (≥18 years old) scheduled for CXR and CT were invited to enroll as participants through an opt-out process. Reports and images were de-identified, processed retrospectively, and AI-flagged discrepant findings were assigned to two lead radiologists, each blinded to patient identifiers and original radiologist. The radiologist's findings for each clinical condition were tallied as a verified discrepancy (true positive) or not (false positive). Results The missed findings were: 0.02% rib fractures, 0.51% aortic aneurysm, 0.32% pulmonary nodules, 0.92% emphysema, and 0.28% pulmonary embolism. The positive predictive values (PPVs) were: pneumothorax (0%), rib fractures (5.6%), aortic dilatation (43.2%), pulmonary emphysema (46.0%), pulmonary embolus (11.5%), and pulmonary nodules (9.2%). The PPV for pneumothorax was nil owing to lack of available studies that were analysed for outpatient activity. Conclusions The number of missed findings was far less than generally predicted. The chest algorithms deployed retrospectively were a useful quality tool and AI augmented the radiologists' workflow. Advances in knowledge The diagnostic accuracy of our radiologists generated missed findings of 0.02% for rib fractures CXR, 0.51% for aortic dilatation, 0.32% for pulmonary nodule, 0.92% for pulmonary emphysema, and 0.28% for pulmonary embolism for CT studies, all retrospectively evaluated with AI used as a quality tool to flag potential missed findings. It is important to account for prevalence of these chest conditions in clinical context and use appropriate clinical thresholds for decision-making, not relying solely on AI.
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Affiliation(s)
- Bahadar S Bhatia
- Directorate of Diagnostic Radiology, Sandwell & West Birmingham NHS Trust, Lyndon, West Bromwich B71 4HJ, United Kingdom
- Space Research Centre, Physics & Astronomy, University of Leicester, 92 Corporation Road, Leicester LE4 5SP, United Kingdom
| | - John F Morlese
- Directorate of Diagnostic Radiology, Sandwell & West Birmingham NHS Trust, Lyndon, West Bromwich B71 4HJ, United Kingdom
| | - Sarah Yusuf
- Directorate of Diagnostic Radiology, Sandwell & West Birmingham NHS Trust, Lyndon, West Bromwich B71 4HJ, United Kingdom
| | - Yiting Xie
- Merge, Merative (Formerly, IBM Watson Health Imaging), Ann Arbor, Michigan, MI 48108, United States
| | - Bob Schallhorn
- Merge, Merative (Formerly, IBM Watson Health Imaging), Ann Arbor, Michigan, MI 48108, United States
| | - David Gruen
- Jefferson Radiology and Radiology Partners, 111 Founders Plaza, East Hartford, Connecticut CT 06108, United States
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Bordes SJ, Greiffenstein P. Early surgical stabilization of rib fractures (SSRF) is better, but delayed SSRF is not worse. J Thorac Dis 2023; 15:6403-6404. [PMID: 38249907 PMCID: PMC10797338 DOI: 10.21037/jtd-2023-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
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18
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Tang Y, Hong W, Xu X, Li M, Jin L. Traumatic rib fracture patterns associated with bone mineral density statuses derived from CT images. Front Endocrinol (Lausanne) 2023; 14:1304219. [PMID: 38155951 PMCID: PMC10754511 DOI: 10.3389/fendo.2023.1304219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background The impact of decreased bone mineral density (BMD) on traumatic rib fractures remains unknown. We combined computed tomography (CT) and artificial intelligence (AI) to measure BMD and explore its impact on traumatic rib fractures and their patterns. Methods The retrospective cohort comprised patients who visited our hospital from 2017-2018; the prospective cohort (control group) was consecutively recruited from the same hospital from February-June 2023. All patients had blunt chest trauma and underwent CT. Volumetric BMD of L1 vertebra was measured by using an AI software. Analyses were done by using BMD categorized as osteoporosis (<80 mg/cm3), osteopenia (80-120 mg/cm3), or normal (>120 mg/cm3). Pearson's χ2, Fisher's exact, or Kruskal-Wallis tests and Bonferroni correction were used for comparisons. Negative binomial, and logistic regression analyses were used to assess the associations and impacts of BMD status. Sensitivity analyses were also performed. Findings The retrospective cohort included 2,076 eligible patients, of whom 954 (46%) had normal BMD, 806 (38.8%) had osteopenia, and 316 (15.2%) had osteoporosis. After sex- and age-adjustment, osteoporosis was significantly associated with higher rib fracture rates, and a higher likelihood of fractures in ribs 4-7. Furthermore, both the osteopenia and osteoporosis groups demonstrated a significantly higher number of fractured ribs and fracture sites on ribs, with a higher likelihood of fractures in ribs 1-3, as well as flail chest. The prospective cohort included 205 eligible patients, of whom 92 (44.9%) had normal BMD, 74 (36.1%) had osteopenia, and 39 (19.0%) had osteoporosis. The findings observed within this cohort were in concurrence with those in the retrospective cohort. Interpretation Traumatic rib fractures are associated with decreased BMD. CT-AI can help to identify individuals who have decreased BMD and a greater rib fracture rate, along with their fracture patterns.
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Affiliation(s)
- Yilin Tang
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
| | - Wei Hong
- Department of Geriatrics and Gerontology, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
| | - Xinxin Xu
- Clinical Research Center for Geriatric Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
| | - Ming Li
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
- Diagnosis and Treatment Center of Small Lung Nodules, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
| | - Liang Jin
- Radiology Department, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
- Diagnosis and Treatment Center of Small Lung Nodules, Huadong Hospital, Affiliated with Fudan University, Shanghai, China
- Radiology Department, Huashan Hospital Affiliated with Fudan University, Shanghai, China
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Intepe OG, Guner Akbiyik A. Single-Center Experience in Cases With Rib Fractures: When To Be Alert? Cureus 2023; 15:e50060. [PMID: 38186497 PMCID: PMC10769462 DOI: 10.7759/cureus.50060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
AIM The aim of this study was to evaluate rib fracture-related complications in blunt chest traumas. METHODOLOGY The study included a cohort of 132 male and 42 female patients, aged between 22 and 89 years, all diagnosed with rib fractures subsequent to blunt chest trauma. The data collection period extended from November 2017 to November 2019. Pulmonary complications, including pneumothorax, hemothorax, pulmonary contusion, flail chest, and the need for mechanical ventilator support, were retrospectively evaluated based on age, gender, trauma history, bilateral fractures, the number of fractured ribs, and concomitant traumas in other systems. Patients with one or two fractured ribs were included in Group 1, while those with three or more rib fractures were in Goup 2. RESULTS Patients in Group 2 (n=82) had a significantly higher mean age and complication rate compared to patients in Group 1 (56.24 vs. 51.08; p: 0.033; p=0.000). Falls from height were the most common trauma history. The most frequently broken ribs were the fifth right (n=35) and the ninth right ribs (n=35), followed by the seventh right (n=33) and the seventh left rib (n=32) in order. Pneumothorax was diagnosed in 60 patients (34.4%), hemothorax in 48 patients (27.5%), and pulmonary contusion in 22 patients (12.6%). Seven patients had a flail chest (4.0%) and four required mechanical ventilation support. The number of male patients was significantly higher (p=0.000). Motor vehicle accidents were most correlated with complications in trauma history (p=0.002). Elderly age, bilateral fractures, three or more fractured ribs, and the mechanism of trauma were significantly correlated with complications (p < 0.05). The mortality rate was 0%. CONCLUSION Three or more fractured ribs, bilateral fractures, and high-energy traumas are important risk factors, particularly in the elderly population. For patients meeting these criteria, hospitalization and careful observation are recommended.
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Affiliation(s)
- Omer Giray Intepe
- Thoracic Surgery, Republic of Türkiye Ministry of Health, Ali Osman Sonmez Oncology Hospital, Bursa, TUR
| | - Ayten Guner Akbiyik
- Thoracic Surgery, Republic of Türkiye Ministry of Health, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, TUR
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20
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Dakic Z, Kantar M, Bjelosevic B, Strbac B, Stranatic M, Jerkic R. Rib fragment compressing aorta in patient with chest and spinal injuries. Trauma Surg Acute Care Open 2023; 8:e001261. [PMID: 38020865 PMCID: PMC10649780 DOI: 10.1136/tsaco-2023-001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Zoran Dakic
- Thoracic Surgery Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Marko Kantar
- Thoracic Surgery Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Bojan Bjelosevic
- Thoracic Surgery Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Branko Strbac
- Thoracic Surgery Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Miroslav Stranatic
- Thoracic Surgery Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Radomir Jerkic
- Thoracic Surgery Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
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21
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Tichenor M, Reparaz LB, Watson C, Reeves J, Prest P, Fitzgerald M, Patel N, Tan X, Hessey J. Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture technique. Trauma Surg Acute Care Open 2023; 8:e001201. [PMID: 37936903 PMCID: PMC10626755 DOI: 10.1136/tsaco-2023-001201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023] Open
Abstract
Background Surgical stabilization of rib fractures (SSRF) has been shown to improve outcomes, yet there is an absence of studies comparing SSRF techniques. An intrathoracic system that minimizes incision length has recently been developed and adopted by multiple institutions. We hypothesized that SSRF with an intrathoracic system plus intercostal nerve cryoneurolysis (IC) leads to improved pain control compared with an extrathoracic system plus IC. Methods A single-center, retrospective chart review was performed comparing intrathoracic SSRF versus extrathoracic SSRF, and included patients undergoing SSRF from 2015 to 2021 at a level 1 trauma center. Patients who did not undergo intercostal nerve cryoablation were excluded. The primary outcome was opioid consumption based on morphine milligram equivalent (MME) consumption. We collected Rib score, Blunt Pulmonary Contusion 18 Score, number of rib fractures, number of ribs plated, and Injury Severity Score (ISS) to compare baseline characteristics of each group. Results A total of 112 patients were evaluated for study inclusion. Thirty-one patients were excluded due to missing outcomes data and/or lack of cryoablation. There was no difference in ISS or Rib Score between the intrathoracic (n=33) and extrathoracic (n=48) groups. At 7-day follow-up, the median MME requirement was significantly lower in the intrathoracic group (21.25) versus the extrathoracic group (46.20) (p=0.02). Conclusion Intrathoracic SSRF was associated with a lower postoperative MME consumption compared with extrathoracic SSRF. These data support the use of intrathoracic SSRF to improve pain control compared to extrathoracic SSRF. Level of evidence III.
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Affiliation(s)
- Michael Tichenor
- Department of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USA
| | - Laura B. Reparaz
- Department of Trauma Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USA
| | - Christopher Watson
- Department of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USA
| | - Jeremy Reeves
- Department of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USA
| | - Phillip Prest
- Department of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USA
| | - Michael Fitzgerald
- Department of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USA
| | - Neema Patel
- Department of General Surgery, Mount Sinai South Nassau, Oceanside, New York, USA
| | - Xiyan Tan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina, USA
| | - Jacob Hessey
- Department of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USA
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22
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Buchholz CJ, Jia L, Manea C, Petersen T, Wang H, Stright A, Young J, Calland JF. Revised Intensity Battle Score (RIBS): Development of a Clinical Score for Predicting Poor Outcomes After Rib Fractures. Am Surg 2023; 89:4668-4674. [PMID: 36120831 DOI: 10.1177/00031348221123087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with rib fractures have variable clinical courses and it is difficult to predict which patients will do poorly. Ideally this prediction would happen at the time of admission to facilitate effective triage. One scoring system devised to this end, is the Battle score. This study aims to evaluate the efficacy of the Battle score as triage tool, and to re-tool it for performance in an inpatient trauma setting. METHODS A multivariate logistic regression model was trained on patients admitted to a level one trauma center with at least one rib fracture. A composite outcome was used to classify those who had poor outcomes. Eighteen candidate predictors were analyzed in univariate analysis, then the most promising fed into the logistic model until a triage score was built and internally validated by bootstrapping. RESULTS Of the 838 patients who met the inclusion criteria, 145 (17.3%) patients had a defined poor outcome. The relevant predictors included in the final scoring system were number of ribs fractured, chest tube, pulmonary contusions, chronic obstructive pulmonary disease, and Glasgow coma score. Age was not found to be predictive. This score was found to have higher fidelity in predicting poor outcomes than the original Battle score (AUROC .858 vs .649.). DISCUSSION An easy to calculate clinical scoring system was created to triage patients with rib fractures at the time of admission. Age may be of less importance than previously thought, while injury burden and history of lung disease may play a larger role.
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Affiliation(s)
- Carl J Buchholz
- Department of Surgery, Virginia Tech Carilion Clinic, Roanoke VA, USA
| | - Leon Jia
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Calin Manea
- Department of General Surgery, Wellspan Health York Hospital, York, PA, USA
| | - Taylor Petersen
- Department of Pediatrics, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Haowei Wang
- Department of Surgery, Strong Memorial Hospital, Rochester, NY, USA
| | - Adam Stright
- Department of Trauma and Acute Care Surgery, NYU Langone Health, New York, NY, USA
| | - Jeffrey Young
- University of Virginia Health System, Charlottesville VA, USA
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23
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Nguyen T, Yu A. Rib Fragility Fractures and Chest Wall Hematoma After Cardiopulmonary Resuscitation Training: A Case Report. Cureus 2023; 15:e47998. [PMID: 38034174 PMCID: PMC10686782 DOI: 10.7759/cureus.47998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Fragility fractures commonly manifest as complications in individuals with diminished bone mineral density and other risk factors. The hip, vertebral body, and wrist are the most documented locations of fragility fractures among patients with osteoporosis or osteopenia. This report presents a rare case of multiple fragility fractures of the right ribs accompanied by an adjacent right chest wall hematoma in an otherwise healthy 60-year-old woman after participating in cardiopulmonary resuscitation (CPR) training. Upon further workup, a diagnosis of osteopenia was established. This report aims to underscore a potential complication in those performing CPR and outline the clinicoradiological presentations, diagnostic workup, and treatment of fragility fractures in patients with no history of prior underlying skeletal conditions or malignancy.
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Affiliation(s)
- Troy Nguyen
- College of Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Amy Yu
- Department of Radiology, Tulane University School of Medicine, New Orleans, USA
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Meyer DE, Harvin JA, Vincent L, Motley K, Wandling MW, Puzio TJ, Moore LJ, Cotton BA, Wade CE, Kao LS. Randomized Controlled Trial of Surgical Rib Fixation to Nonoperative Management in Severe Chest Wall Injury. Ann Surg 2023; 278:357-365. [PMID: 37317861 PMCID: PMC10527348 DOI: 10.1097/sla.0000000000005950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To compare the effectiveness of surgical stabilization of rib fractures (SSRFs) to nonoperative management in severe chest wall injury. BACKGROUND SSRF has been shown to improve outcomes in patients with clinical flail chest and respiratory failure. However, the effect of SSRF outcomes in severe chest wall injuries without clinical flail chest is unknown. METHODS Randomized controlled trial comparing SSRF to nonoperative management in severe chest wall injury, defined as: (1) a radiographic flail segment without clinical flail or (2) ≥5 consecutive rib fractures or (3) any rib fracture with bicortical displacement. Randomization was stratified by the unit of admission as a proxy for injury severity. Primary outcome was hospital length of stay (LOS). Secondary outcomes included intensive care unit (ICU) LOS, ventilator days, opioid exposure, mortality, and incidences of pneumonia and tracheostomy. Quality of life at 1, 3, and 6 months was measured using the EQ-5D-5L survey. RESULTS Eighty-four patients were randomized in an intention-to-treat analysis (usual care = 42, SSRF = 42). Baseline characteristics were similar between groups. The numbers of total fractures, displaced fractures, and segmental fractures per patient were also similar, as were the incidences of displaced fractures and radiographic flail segments. Hospital LOS was greater in the SSRF group. ICU LOS and ventilator days were similar. After adjusting for the stratification variable, hospital LOS remained greater in the SSRF group (RR: 1.48, 95% CI: 1.17-1.88). ICU LOS (RR: 1.65, 95% CI: 0.94-2.92) and ventilator days (RR: 1.49, 95% CI: 0.61--3.69) remained similar. Subgroup analysis showed that patients with displaced fractures were more likely to have LOS outcomes similar to their usual care counterparts. At 1 month, SSRF patients had greater impairment in mobility [3 (2-3) vs 2 (1-2), P = 0.012] and self-care [2 (1-2) vs 2 (2-3), P = 0.034] dimensions of the EQ-5D-5L. CONCLUSIONS In severe chest wall injury, even in the absence of clinical flail chest, the majority of patients still reported moderate to extreme pain and impairment of usual physical activity at one month. SSRF increased hospital LOS and did not provide any quality of life benefit for up to 6 months.
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Affiliation(s)
- David E Meyer
- Department of Surgery; McGovern Medical School at UTHealth Houston, Houston, TX
| | - John A Harvin
- Department of Surgery; McGovern Medical School at UTHealth Houston, Houston, TX
| | - Laura Vincent
- The Center for Translational Injury Research, McGovern Medical School at UTHealth Houston, Houston, TX
| | - Kandice Motley
- The Center for Translational Injury Research, McGovern Medical School at UTHealth Houston, Houston, TX
| | - Michael W Wandling
- Department of Surgery; McGovern Medical School at UTHealth Houston, Houston, TX
| | - Thaddeus J Puzio
- Department of Surgery; McGovern Medical School at UTHealth Houston, Houston, TX
| | - Laura J Moore
- Department of Surgery; McGovern Medical School at UTHealth Houston, Houston, TX
| | - Bryan A Cotton
- Department of Surgery; McGovern Medical School at UTHealth Houston, Houston, TX
| | - Charles E Wade
- The Center for Translational Injury Research, McGovern Medical School at UTHealth Houston, Houston, TX
| | - Lillian S Kao
- Department of Surgery; McGovern Medical School at UTHealth Houston, Houston, TX
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Sidhu GAS, Mahmood A, Pattnaik S, Subratty M, Kaur H, Raja V, Rajagopalan S, Ashwood N. Evaluation of Acute Outcomes and Factors Influencing the Care of Chest Trauma in a District General Hospital in the United Kingdom. Cureus 2023; 15:e45690. [PMID: 37868515 PMCID: PMC10590083 DOI: 10.7759/cureus.45690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Background The rate of chest trauma admissions under the Queen Hospital Burton Orthopedic team has been steadily increasing, surpassing other hospital trusts. Patients are managed locally by the Orthopedic department, unlike in major trauma centres. Understanding the management outcomes and patient factors in this setting is crucial for enhancing patient safety. Methodology A retrospective analysis of 139 patients with chest trauma referred to the QHB Orthopedic team from October 2017 to May 2021 was conducted using the Meditech-V6 electronic medical records system (Meditech, Westwood, US). This study aims to evaluate the outcomes of patients admitted with chest trauma and improve current practices. The objectives include assessing patient factors influencing outcomes, initiating discussions with a major trauma centre, and enhancing the quality of care for chest trauma patients. Results The mechanism of injury in all cases of chest injuries was blunt trauma, accounting for 100% of the cases. The specific mechanisms of injury observed in the study included falls from standing, falls from height, road traffic collisions, and assault. The study comprised 139 individuals, 128 of whom were diagnosed with rib fractures, and 11 who did not have any rib fractures. In addition, two patients were hospitalized with bilateral rib fractures, both of which were life-threatening. Tragically, one of these cases resulted in the death of the patient. With regard to outcomes, 67% of the patients received a consultation at Royal Stoke Hospital (RSH). Eight individuals were transferred to RSH for further management, while the remaining 131 patients were not transferred. Eighty-seven individuals were discharged from the hospital, indicating successful recovery and readiness for discharge. However, it is noteworthy that nine patients experienced complications during their hospital stay, highlighting the potential challenges and risks associated with chest trauma management. Tragically, seven patients succumbed to their injuries and passed away. Conclusions The majority of patients in this study were aged 65 and over and presented with multiple comorbidities, indicating the complex medical profile of this population. However, despite the presence of life-threatening injuries and the associated risks, only a minority of patients in the study were transferred to a designated trauma centre. This raises concerns about the adequacy of the current transfer protocols and the potential impact on patient outcomes.
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Affiliation(s)
- Gur Aziz Singh Sidhu
- Orthopedics, University Hospital Lewisham, London, GBR
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
- Orthopedics and Traumatology, Max Super Speciality Hospital, Delhi, IND
| | - Aveen Mahmood
- Trauma and Orthopaedics, Queen's Hospital Burton, Burton-on-Trent, GBR
| | | | - Mohammed Subratty
- Trauma and Orthopaedics, Queen's Hospital Burton, Burton-on-Trent, GBR
| | - Harjot Kaur
- Anaesthesia, Queen Elizabeth Hospital, London, GBR
| | - Venkataraman Raja
- Trauma and Orthopaedics, Queen's Hospital Burton, Burton-on-Trent, GBR
| | - Shyam Rajagopalan
- Trauma and Orthopaedics, Queen's Hospital Burton, Burton-on-Trent, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, Queen's Hospital Burton, Burton-on-Trent, GBR
- Trauma and Orthopaedics, Research Institute of Healthcare Sciences, University of Wolverhampton, Wolverhampton, GBR
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Dönmez S, Erdem AB, Şener A, Altaş F, Mutlu Rİ. Placebo-controlled randomized double-blind comparison of the analgesic efficacy of lidocaine spray and etofenamate spray in pain control of rib fractures. ULUS TRAVMA ACIL CER 2023; 29:929-934. [PMID: 37563892 PMCID: PMC10560796 DOI: 10.14744/tjtes.2023.40652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/24/2023] [Accepted: 04/23/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND As far as we could detect, we could not find any study in literature on the analgesic efficacy of spray forms of lidocaine and etofenamate in rib fractures. In this study, our aim is to empirically compare the analgesic efficacy of etofenamate spray, lidocaine 10% spray and placebo spray in the management of pain secondary to trauma secondary to isolated rib fractures. METHODS The study was designed according to a single-center, prospective, randomized, placebo-controlled double-blind study model. About 30 sealed envelopes were prepared for each of the 3 groups and 30 patients were included in each group. A total of 84 cases were included in the study (three groups: 27, 28, 29). RESULTS Numeric rating scale (NRS) grades at admission and at 15-30-60-120 min were similar between the three groups (P>0.05). Analysis findings of NRS perception differences between the initial NRS level and the 15-30-60-120th min NRS difference at the 0-120th min showed more lidocaine spray organs, and it was not clearly perceived that these four parameters went between the 3 groups for the outline. CONCLUSION The analgesic efficacy of lidocaine 10% spray, etofenamate spray, and placebo spray used together with standard dexketoprofen 50 mg intravenous treatment in the pain management of rib fractures were similar to each other and although there was a difference at the 120th min, this difference was not statistically significant.
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Affiliation(s)
- Safa Dönmez
- Department of Emergency, Ankara Bilkent City Hospital, Ankara-Türkiye
| | | | - Alp Şener
- Department of Emergency Medicine, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara-Türkiye
| | - Furkan Altaş
- Department of Emergency, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Reyhan İrem Mutlu
- Department of Emergency, Ankara Bilkent City Hospital, Ankara-Türkiye
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Faliks B, Thomas E, Forrester JD. Surgical fixation of a traumatic fracture through a congenitally anomalous sternum: a case report. Trauma Surg Acute Care Open 2023; 8:e001155. [PMID: 37484835 PMCID: PMC10360415 DOI: 10.1136/tsaco-2023-001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Affiliation(s)
- Bradley Faliks
- Department of Surgery, HonorHealth Scottsdale Osborn Medical Center, Scottsdale, Arizona, USA
| | - Evan Thomas
- College of Medicine, Washington State University, Spokane, Washington, USA
| | - Joseph D Forrester
- Departments of Surgery and Medicine, Stanford University, Stanford, California, USA
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Jivani HB, Joshi P, Dsouza J. Beyond the Surface: Exploring Chest Trauma With Conventional Radiography and CT. Cureus 2023; 15:e41750. [PMID: 37575706 PMCID: PMC10415853 DOI: 10.7759/cureus.41750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Traumatic injuries to the chest are a frequent cause of mortality among young individuals. Imaging plays a crucial role in the management of thoracic trauma, providing essential details for accurate diagnosis and treatment. OBJECTIVE To assess the respective contributions of radiography and CT in cases of chest trauma. SETTINGS AND DESIGN We assessed 64 subjects, gathering findings from both CT scans and radiographic imaging. The results were organized into a table, considering various variables such as subcutaneous emphysema, rib fractures, clavicular fractures, sternal fractures, scapular fractures, vertebral fractures, pneumothorax, pneumomediastinum, hemothorax, lung contusions, diaphragmatic injuries, and lung herniations. We analyzed the incidence and mode of injury for each variable. Additionally, we compared the sensitivity and specificity of radiographs to CT scans. RESULTS The leading cause of chest trauma was road traffic accidents (RTAs) (67.2%). The most common age groups affected were 18-30 years (31.3%) and 30-40 years (25%). Rib fractures (73.4%), contusions (70.3%), and hemothorax (62.5%) were the most frequently observed findings. Comparing the detection rates of contusions, rib fractures, hemothorax/pleural effusions, pneumothorax/pneumomediastinum, radiographs exhibited lower sensitivity than CT scans (p-value < 0.05 for all comparisons). CONCLUSIONS In the assessment of trauma patients, chest radiographs continue to serve as the primary screening method, while CT scans are the preferred imaging technique. CT scans are preferable to radiographs in subjects who are clinically stable, providing valuable information. However, for subjects who are unstable, CT scans become even more indispensable, as they offer critical insights into their condition.
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Affiliation(s)
- Hit B Jivani
- Radiology, Bharati Vidyapeeth DTU (Deemed to be University) Medical College and Hospital, Pune, IND
| | - Priscilla Joshi
- Radiology, Bharati Vidyapeeth DTU (Deemed to be University) Medical College and Hospital, Pune, IND
| | - John Dsouza
- Radiology, Bharati Vidyapeeth DTU (Deemed to be University) Medical College and Hospital, Pune, IND
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Field F, Olsson J, Hurley A. Alcohol Dependence and Rib Fracture Outcomes: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e42639. [PMID: 37644941 PMCID: PMC10461216 DOI: 10.7759/cureus.42639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Chronic alcohol use has been associated with impaired pulmonary function, increased risk of pneumonia and poor outcomes after trauma. With a high incidence of rib fractures in this population, the clinical and physiological factors associated with alcohol dependence may influence how these patients recover from thoracic injuries. Therefore, the aim of the systematic review was to examine the effect of alcohol dependence on rib fracture outcomes. The Embase, PubMed and Web of Science databases were searched for studies examining adult patients with rib fractures, with and without a history of alcohol dependency. The outcomes of interest were mortality, pulmonary complications, intensive care length of stay, ventilator days and hospital length of stay. A meta-analysis was performed to combine the data and compare results. Three studies met the criteria for inclusion in the review and all studies were observational in design. Alcohol dependency was associated with increased mortality (OR 1.44 (95% CI: 1.33-1.56)), pneumonia (OR 2.14 (2.02-2.27)) and ARDS (OR 1.71(1.48-1.98)) as well as longer stays in hospital and intensive care (p<0.05). No difference was found in ventilator days between the two groups. Early intensive care review should be considered to reduce complications in this population alongside prompt management of withdrawal symptoms. However, limited primary research exists on this topic and the quality of current evidence is low. Additional primary research is needed to further understand this correlation and draw meaningful conclusions.
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Affiliation(s)
- Fiona Field
- Trauma Sciences, Queen Mary University of London, London, GBR
| | - Jenny Olsson
- Anaesthetics, King's College Hospital NHS Foundation Trust, London, GBR
| | - Anna Hurley
- Plastic Surgery, Hull University Teaching Hospitals, Hull, GBR
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Murray-Ramcharan M, Valdivieso S, Mohamed I, Altonen B, Safavi A. Outcomes of surgical stabilization of rib fractures in a minority population: Retrospective analysis of a case series from an acute care facility. JTCVS Open 2023; 14:581-589. [PMID: 37425453 PMCID: PMC10328799 DOI: 10.1016/j.xjon.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 07/11/2023]
Abstract
Objective The aim of was to examine the postoperative outcomes and associated factors of surgical stabilization of rib fracture (SSRF) in a minority population. Methods A retrospective analysis with case series of 10 patients undergoing SSRF at an acute care facility in New York City was performed. Data, including patient demographic characteristics, comorbidities, hospital length of stay were collected. Results were presented in comparative tables and a Kaplan-Meier curve. Primary outcome was to compare outcomes of SSRF in minority patients to larger studies in nonminority populations. Secondary outcomes included various postoperative outcomes, including atelectasis, pain, and infection, and the influence of medical comorbidities on each. Results The median time (with accompanying interquartile range) from diagnosis to SSRF, SSRF to discharge, and overall length of stay was 4.5 days (4.25), 6.0 days (17.00) and 10.5 days (18.25) days, respectively. The time until SSRF and postoperative complication rate were found to be comparable to those in larger studies. The Kaplan-Meier curve demonstrates a correlation between persistence of atelectasis to increased length of stay (P = .05). Increased time to SSRF was seen in elderly patients and patients with diabetes (P = .012 and P = .019, respecively). Increased pain requirements by patients with diabetes (P = .007), and higher infectious complications in patients with flail chest and diabetes (P = .035 and P = .002, respectively) were also seen. Conclusions Preliminary outcomes and complication rates of SSRF in a minority population are shown to be comparable to larger studies in nonminority populations. Larger, higher-powered studies are required to further compare outcomes between these 2 populations.
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Affiliation(s)
- Max Murray-Ramcharan
- Department of Surgery, Harlem Hospital Center, Columbia University, New York, NY
| | - Sebastian Valdivieso
- Department of Surgery, Harlem Hospital Center, Columbia University, New York, NY
| | - Ibrahim Mohamed
- Department of Surgery, Harlem Hospital Center, Columbia University, New York, NY
| | - Brian Altonen
- Division of Population Health and Research Administration, NYC Health & Hospitals, New York, NY
| | - Ali Safavi
- Division of Thoracic Surgery, Department of Surgery, Harlem Hospital, Columbia University, New York, NY
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Forrester JD, Faliks B, Cardarelli C, Choudhry MS, Patel B, Ricaurte D, Sarani B, Sfakianos M, Kartiko S, Huston JM. Chest Wall Injury Society Recommendations for Management of Surgical Site or Implant-Related Infections After Surgical Stabilization of Traumatic Rib or Sternal Fractures. Surg Infect (Larchmt) 2023. [PMID: 37204325 DOI: 10.1089/sur.2023.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Background: Surgical stabilization of rib fractures (SSRF) and surgical stabilization of sternal fractures (SSSF) involves open reduction and internal fixation of fractures with an implantable titanium plate to restore and maintain anatomic alignment. The presence of this foreign, non-absorbable material presents an opportunity for infection. Although surgical site infection (SSI) and implant infection rates after SSRF and SSSF are low, they present a challenging clinical entity. Methods: The Surgical Infection Society's Therapeutics and Guidelines Committee and Chest Wall Injury Society's Publication Committee convened to develop recommendations for management of SSIs or implant-related infections after SSRF or SSSF. PubMed, Embase, Web of Science and the Cochrane database were searched for pertinent studies. Using a process of iterative consensus, all committee members voted to accept or reject each recommendation. Results: For patients undergoing SSRF or SSSF who develop an SSI or an implant-related infection, there is insufficient evidence to suggest a single optimal management strategy. For patients with an SSI, systemic antibiotic therapy, local wound debridement, and vacuum-assisted closure have been used in isolation or combination. For patients with an implant-related infection, initial implant removal with or without systemic antibiotic therapy, systemic antibiotic therapy with local wound drainage, and systemic antibiotic therapy with local antibiotic therapy have been documented. For patients who do not undergo initial implant removal, 68% ultimately require implant removal to achieve source control. Conclusions: Insufficient evidence precludes the ability to recommend guidelines for the treatment of SSI or implant-related infection following SSRF or SSSF. Further studies should be performed to identify the optimal management strategy in this population.
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Affiliation(s)
- Joseph D Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Bradley Faliks
- Department of Surgery, HonorHealth Scottsdale Osborn Medical Center, Phoenix, Arizona, USA
| | - Cassandra Cardarelli
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | | | - Bhavik Patel
- Division of Trauma, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Daniel Ricaurte
- Department of Acute Care Surgery, Hartford Hospital, Hartford, Connecticut, USA
| | - Babak Sarani
- Center for Trauma and Critical Care, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Maria Sfakianos
- Division of Trauma and Acute Care Surgery, Departments of Surgery and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Susan Kartiko
- Center for Trauma and Critical Care, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jared M Huston
- Division of Trauma and Acute Care Surgery, Departments of Surgery and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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van Gemert MJC, Zwinderman AH, Koppen PJV, Neumann HAM, Vlaming M. Child Abuse, Misdiagnosed by an Expertise Center-Part II-Misuse of Bayes' Theorem. Children (Basel) 2023; 10:children10050843. [PMID: 37238391 DOI: 10.3390/children10050843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
A newborn girl had, from two weeks on, small bruises on varying body locations, but not on her chest. Her Armenian grandmother easily bruised, too. Her mother was diagnosed with hypermobility-type Ehlers-Danlos-Syndrome (hEDS), an autosomal dominant connective tissue disorder, with a 50% inheritance probability. Referral to a University Medical Center located "Dutch Expertise Center for Child Abuse" resulted (prior to consultation) in physical abuse suspicion. Protocol-based skeletal X-rays showed three healed, asymptomatic rib fractures. A protocol-based Bayesian likelihood ratio guesstimation gave 10-100, erroneously used to suggest a 10-100 times likelier non-accidental-than-accidental cause. Foster care placement followed, even in a secret home, where she also bruised, suggesting hEDS inheritance. Correct non-accidental/accidental Bayes' probability of symptoms is (likelihood ratio) × (physical abuse incidence). From the literature, we derived an infant abuse incidence between about ≈0.0009 and ≈0.0026 and a likelihood ratio of <5 for bruises. For rib fractures, we used a zero likelihood ratio, arguing their cause was birth trauma from the extra delivery pressure on the chest, combined with fragile bones as the daughter of an hEDS-mother. We thus derived a negligible abuse/accidental probability between <5 × 0.0009 <0.005 and <5 × 0.0026 <0.013. The small abuse incidence implies that correctly using Bayes' theorem will also miss true infant physical abuse cases. Curiously, because likelihood ratios assess how more often symptoms develop if abuse did occur versus non-abuse, Bayes' theorem then implies a 100% infant abuse incidence (unwittingly) used by LECK. In conclusion, probabilities should never replace differential diagnostic procedures, the accepted medical method of care. Well-known from literature, supported by the present case, is that (child abuse pediatrics) physicians, child protection workers, and judges were unlikely to understand Bayesian statistics. Its use without statistics consultation should therefore not have occurred. Thus, Bayesian statistics, and certainly (misused) likelihood ratios, should never be applied in cases of physical child abuse suspicion. Finally, parental innocence follows from clarifying what could have caused the girl's bruises (inherited hEDS), and rib fractures (birth trauma from fragile bones).
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Affiliation(s)
- Martin J C van Gemert
- Department of Biomedical Engineering & Physics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology & Bio-Statistics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Peter J van Koppen
- Department of Criminal Law and Criminology, Faculty of Law, VU University, 1081 HV Amsterdam, The Netherlands
| | | | - Marianne Vlaming
- Private Practice, Criminal Psychology and Law, 6986 CL Angerlo, The Netherlands
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Hamamoto N, Kikuta S, Takahashi R, Ishihara S. Delayed Tension Hemothorax With Nondisplaced Rib Fractures After Blunt Thoracic Trauma. Cureus 2023; 15:e38835. [PMID: 37303319 PMCID: PMC10254092 DOI: 10.7759/cureus.38835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Blunt thoracic trauma often causes rib fractures, hemothorax, and pneumothorax. Although there is no established definition regarding the duration and management of delayed hemothorax, it commonly occurs in a few days and exhibits at least one displaced rib fracture. Moreover, delayed hemothorax rarely develops tension hemothorax. A 58-year-old male who had a motorcycle accident received conservative treatment from his orthopedic doctor. He felt a sudden severe chest pain 19 days after the accident. Contrast-enhanced computed tomography (CT) of the chest revealed multiple left-sided rib fractures without displacement, left pleural effusion, and extravasation near the intercostal space of the seventh rib fracture. After transfer to our hospital and a plain CT scan, which showed a more mediastinal shift toward the right, his condition deteriorated with cardiorespiratory embarrassment, such as restlessness, hypotension, and neck vein distention. We diagnosed him with obstructive shock due to tension hemothorax. Immediate chest drainage ameliorated restlessness and elevated blood pressure. Here, we report an extremely rare and atypical case of delayed tension hemothorax after blunt thoracic trauma without displaced rib fractures.
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Affiliation(s)
- Nana Hamamoto
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN
| | - Shota Kikuta
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN
| | - Ryo Takahashi
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN
| | - Satoshi Ishihara
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, JPN
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Collis J, Farquharson B, Chan S, Dickson-Lowe R. The Implementation of a Rib Fracture Pathway at a Small District General Hospital to Improve Patient Care. Cureus 2023; 15:e38863. [PMID: 37303343 PMCID: PMC10257064 DOI: 10.7759/cureus.38863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Background and objective Rib fractures are common presentations to the emergency department following blunt thoracic trauma. Despite this injury causing significant morbidity and mortality, no national guidelines exist to guide the acute management of this condition. In light of this, this quality improvement project was conducted at a district general hospital (DGH) with the aim of assessing the impact of using a simple rib fracture management pathway. Methods A retrospective review of paper notes and electronic databases of patients with a recorded diagnosis of "rib fractures" were reviewed. Following this, a management pathway was designed and then implemented, which incorporated BMJ Best Practices and local hospital needs. The study then assessed the impact of the pathway. Results Prior to implementing the pathway, a total of 47 individual patients were included in the statistical analysis. Of the patients analysed, 44% were older than 65 years. Of note, 89% received regular paracetamol for analgesia, 41% received regular nonsteroidal anti-inflammatory drugs (NSAIDs), and 69% received regular opioids. Advanced analgesics such as patient-controlled analgesia (PCA) and nerve blocks were poorly used; for instance, a PCA was used in only 13% of cases. Only 6% of patients received daily pain team reviews and only 44% of patients were seen by physiotherapists within the first 24 hours. Additionally, 93% of patients who were admitted under general surgery had a STUMBL (STUdy of the Management of BLunt chest wall trauma) prognostic score >10. Post-pathway implementation, a total of 22 individual patients were included in the statistical analysis. Of them, 52% were older than 65 years. The use of simple analgesia was unchanged. However advanced analgesia was better escalated, and PCAs were used 43% of the time. The involvement of other healthcare professionals improved; 59% were reviewed by the pain team in the first 24 hours, 45% received daily pain team reviews, and 54% received advanced analgesia. Conclusion Based on our findings, implementing a simple rib fracture pathway is effective at improving the management of rib fracture patients admitted to our DGH.
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Affiliation(s)
- Justin Collis
- General Surgery, Medway Maritime NHS Foundation Trust, Gillingham, GBR
| | | | - Shirley Chan
- General Surgery, Medway Maritime NHS Foundation Trust, Gillingham, GBR
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Muhamed S, Vassy M, Konzelmann J, Gibson J, Pack L. Utility of an Emergency Department Observation Unit in Providing Care for Patients With Blunt Thoracic Trauma. Cureus 2023; 15:e39447. [PMID: 37378177 PMCID: PMC10291999 DOI: 10.7759/cureus.39447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Background The use of Emergency Department Observation Units (EDOUs) to treat patients with a variety of complaints has grown over recent years. However, the treatment of patients with traumatic injuries in EDOUs is infrequently described. Our study sought to describe the feasibility of treating patients with blunt thoracic trauma in an EDOU in consultation with our trauma and acute care surgery (TACS) team. Together, our Emergency Department (ED) and TACS teams designed a protocol for the treatment of patients with specific blunt thoracic injuries (fewer than three rib fractures, nondisplaced sternal fractures) that we felt would require less than 24 hours of care in a hospital setting. Methods This study is an IRB-approved retrospective analysis comparing two groups before (pre-EDOU) and after (EDOU) the creation of the EDOU protocol, which was implemented in August 2020. Data was collected at a single, Level 1 trauma center with approximately 95,000 annual visits. Similar inclusion and exclusion criteria were used to select patients in both groups. We conducted two-sample t-tests and Chi-square testing to assess for significance. Primary outcomes include length of stay and bounce-back rate. Results A total of 81 patients were included in our data set across both groups. Forty-three patients were included in our pre-EDOU group while 38 patients were treated in our EDOU once the protocol was implemented. Patients in both groups were of similar age, gender and had similar Injury Severity Scores (ISS) ranging from 9 to 14. Hospital length of stay was shorter for the EDOU group (31.5 hours) compared to the pre-EDOU group (36.4 hours) although not statistically significant. When risk stratified by ISS, hospital length of stay did reach statistical significance and was found to be shorter for patients with ISS scores greater than or equal to 9 that were treated in the EDOU (29.1 hours vs. 43.8 hours, p = .028). Both groups had one patient each bounce back for repeat evaluation and additional care. Conclusion This study demonstrates the potential use of EDOUs to treat patients with mild to moderate blunt thoracic injuries. The availability of trauma surgeons for consultation along with ED provider experience may be rate-limiting steps in utilizing observation units to care for trauma patients. Additional research with more participants is needed to determine the impact of implementing such a practice at other institutions.
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Affiliation(s)
- Shehzad Muhamed
- Emergency Medicine, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Matthew Vassy
- Trauma and Acute Care Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Jason Konzelmann
- Emergency Medicine, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Jesse Gibson
- Trauma and Acute Care Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Leigh Pack
- Trauma and Acute Care Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
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Rogers FB, Larson NJ, Rhone A, Amaya D, Olson-Bullis BA, Blondeau BX. Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians. J Intensive Care Med 2023; 38:327-339. [PMID: 36600614 DOI: 10.1177/08850666221148644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Rib fractures are present in 15% of all traumas and 60% of patients with chest traumas. Rib fractures are not life-threatening in isolation, but they can be quite painful which leads to splinting and compromise of respiratory function. Splinting limits the ability of a patient to take a deep breath, which leads to atelectasis, atelectasis to poor secretion removal, and poor secretion removal leads to pneumonia. Pneumonia is the common pathway to respiratory failure in patients with rib fractures. It is noted that in the elderly, each rib fracture increases developing pneumonia by 27% and the risk of dying by 19%. From a public health perspective, rib fractures have long-term implications with only 59% of patients returning to work at 6 months. In this review we will examine the state of art as it currently exists with regard to the management of pain associated with rib fractures. Included in this overview will be a brief review of the anatomy of the thorax and some important physiologic concepts, the latest trends in pharmacologic and noninvasive means of managing rib pain, a special section on epidural anesthesia, some other alternative invasive methods of pain control, and a review of the recent literature on rib plating. Finally, a practical, easy to follow guideline, to manage the patient with pain from rib fractures will be presented.
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Battle C, Pelo C, Hsu J, Driscoll T, Whitbeck S, White T, Webb M. Expert consensus guidance on respiratory physiotherapy and rehabilitation of patients with rib fractures: An international, multidisciplinary e-Delphi study. J Trauma Acute Care Surg 2023; 94:578-583. [PMID: 36728349 PMCID: PMC10045972 DOI: 10.1097/ta.0000000000003875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/07/2022] [Accepted: 12/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is limited research supporting optimal respiratory physiotherapy or physical rehabilitation strategies for patients with rib fractures. The aim of this study was to develop key recommendations for the physiotherapy management of patients with rib fractures. METHODS A three-round modified e-Delphi survey design, using an international Delphi panel including physiotherapy clinicians, researchers and lecturers, physician associates, trauma surgeons, and intensivists, was used in this study. The draft recommendations were developed by the Steering Group, based on available research. Over three rounds, panelists rated their agreement (using a Likert scale) with regard to recommendation for physiotherapists delivering respiratory physiotherapy and physical rehabilitation to patients following rib fractures. Recommendations were retained if they achieved consensus (defined as ≥70% of panelists ≥5/7) at the end of each round. RESULTS A total of 121 participants from 18 countries registered to participate in the study, with 87 (72%), 77 (64%), and 79 (65%) registrants completing the three rounds, respectively. The final guidance document included 18 respiratory physiotherapy and rehabilitation recommendations, mapped over seven clinical scenarios for patients (1) not requiring mechanical ventilation, (2) requiring mechanical ventilation, (3) with no concurrent fracture of the shoulder girdle complex, (4) with a concurrent fracture of the shoulder girdle complex, (5) with/without concurrent upper limb orthopedic injuries, (6) undergoing surgical stabilization of rib fractures, and (7) at hospital discharge. CONCLUSION This guidance provides key recommendations for respiratory physiotherapy and physical rehabilitation of patients with rib fractures. It could also be used to inform future research priorities in the field. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Shiroff AM, Wolf S, Wu A, Vanderkarr M, Anandan M, Ruppenkamp JW, Galvain T, Holy CE. Outcomes of surgical versus nonsurgical treatment for multiple rib fractures: A US hospital matched cohort database analysis. J Trauma Acute Care Surg 2023; 94:538-545. [PMID: 36730674 PMCID: PMC10045967 DOI: 10.1097/ta.0000000000003828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Treatment for multiple rib fractures includes surgical stabilization of rib fractures (SSRF) or nonoperative management (NOM). Meta-analyses have demonstrated that SSRF results in faster recovery and lower long-term complication rates versus NOM. Our study evaluated postoperative outcomes for multiple rib fracture patients following SSRF versus NOM in a real-world, all-comer study design. METHODS Multiple rib fracture patients with inpatient admissions in the PREMIER hospital database from October 1, 2015, to September 30, 2020, were identified. Outcomes included discharge disposition, and 3- and 12-month lung-related readmissions. Demographics, comorbidities, concurrent injuries at index, Abbreviated Injury Scale and Injury Severity Scores, and provider characteristics were determined for all patients. Patients were excluded from the cohort if they had a thorax Abbreviated Injury Scale score of <2 (low severity patient) or a Glasgow Coma Scale score of ≤8 (extreme high severity patient). Stratum matching between SSRF and NOM patients was performed using fine stratification and weighting so that all patient data were kept in the final analysis. Outcomes were analyzed using generalized linear models with quasinormal distribution and logit links. RESULTS A total of 203,450 patients were included, of which 200,580 were treated with NOM and 2,870 with SSRF. Compared to NOM, patients with SSRF had higher rates of home discharge (62% SSRF vs. 58% NOM) and lower rates of lung-related readmissions (3 months, 3.1% SSRF vs. 4.0% NOM; 12 months, 6.2% SSRF vs. 7.6% NOM). The odds ratio (OR) for home or home health discharge in patients with SSRF versus NOM was 1.166 (95% confidence interval [CI], 1.073-1.266; p = 0.0002). Similarly, ORs for lung-related readmission at 3- and 12-month were statistically lower in the patients treated with SSRF versus NOM (OR [3 months], 0.764 [95% CI, 0.606-0.963]; p = 0.0227 and OR [12 months], 0.799 [95% CI, 0.657-0.971]; p = 0.0245). CONCLUSION Surgical stabilization of rib fractures results in greater odds of home discharge and lower rates of lung-related readmissions compared with NOM at 12 months of follow-up. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Wang X, Wang Y. Composite Attention Residual U-Net for Rib Fracture Detection. Entropy (Basel) 2023; 25:466. [PMID: 36981354 PMCID: PMC10047421 DOI: 10.3390/e25030466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Computed tomography (CT) images play a vital role in diagnosing rib fractures and determining the severity of chest trauma. However, quickly and accurately identifying rib fractures in a large number of CT images is an arduous task for radiologists. We propose a U-net-based detection method designed to extract rib fracture features at the pixel level to find rib fractures rapidly and precisely. Two modules are applied to the segmentation network-a combined attention module (CAM) and a hybrid dense dilated convolution module (HDDC). The features of the same layer of the encoder and the decoder are fused through CAM, strengthening the local features of the subtle fracture area and increasing the edge features. HDDC is used between the encoder and decoder to obtain sufficient semantic information. Experiments show that on the public dataset, the model test brings the effects of Recall (81.71%), F1 (81.86%), and Dice (53.28%). Experienced radiologists reach lower false positives for each scan, whereas they have underperforming neural network models in terms of detection sensitivities with a long time diagnosis. With the aid of our model, radiologists can achieve higher detection sensitivities than computer-only or human-only diagnosis.
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Rudinská LI, Delongová P, Vaculová J, Ihnát P. Pulmonary fat embolism after cardiopulmonary resuscitation. Soud Lek 2023; 68:33-36. [PMID: 37805270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Pulmonary fat embolism (PFE) is usually observed in patients with long bone fractures, patients with extensive subcutaneous fat contusions or skin burns. Chest compressions during cardiopulmonary resuscitation (CPR) present powerful repetitive violence against victim's chest. Skeletal chest fractures are the most frequent complication of CPR, and probably the most important cause of PFE autopsy finding in persons, which have been resuscitated before death. The aim of the present paper was to investigate the prevalence and seriousness of PFE in non-survivors after out-of-hospital cardiac arrest. During autopsy, PFE can be diagnosed in 30 - 42 % of persons after unsuccessful CPR; skeletal chest fractures are associated with significantly higher prevalence of PFE. After successful CPR, fat embolism may contribute significantly to acute respiratory distress syndrome, or multiorgan failure. The issue of CPR associated injuries has two medical aspects - clinical and forensic. From clinical point of view, the presence of CPR associated injuries must be acknowledged when offering healthcare to patients after successful CPR. During autopsy, CPR associated injuries should be diagnosed and evaluated as these injuries may contribute to death or may be potentially lethal.
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Lin CJ, Yeh YS, Lin YK, Chen CW. K-Rod: An Innovative Method of Personalized Rib Splinting for Expeditious Management of Flail Chest in Acute Care Settings. Medicina (B Aires) 2022; 59:medicina59010076. [PMID: 36676700 PMCID: PMC9865151 DOI: 10.3390/medicina59010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023] Open
Abstract
Flail chest is a severe type of multiple rib fracture that can cause ventilation problems and respiratory complications. Historically, flail chest has been mainly managed through pain control and ventilatory support as needed. Operative fixation has recently become popular for the condition, and some studies have revealed its potentially positive effects on the outcomes of patients with flail chest. However, for those for whom surgery is unsuitable, few treatment options, other than simply providing analgesia, are available. Herein, we introduce our innovative method of applying personalized rib splinting for quick management of flail chest, which is easy, tailor-made, and has significant effects on pain reduction.
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Affiliation(s)
- Chia-Jung Lin
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yung-Sung Yeh
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yen-Ko Lin
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Department of Emergency Medicine, Faculty of Medicine, College of Medicine, Kaohsiung 80708, Taiwan
| | - Chao-Wen Chen
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Department of Emergency Medicine, Faculty of Medicine, College of Medicine, Kaohsiung 80708, Taiwan
- Correspondence:
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Jin L, Sun Y, Ma Z, Li M. Radiomics-Based Machine Learning for Predicting the Injury Time of Rib Fractures in Gemstone Spectral Imaging Scans. Bioengineering (Basel) 2022; 10. [PMID: 36671582 DOI: 10.3390/bioengineering10010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
This retrospective study aimed to predict the injury time of rib fractures in distinguishing fresh (30 days) or old (90 days) rib fractures. We enrolled 111 patients with chest trauma who had been scanned for rib fractures at our hospital between January 2018 and December 2018 using gemstone spectral imaging (GSI). The volume of interest of each broken end of the rib fractures was segmented using calcium-based material decomposition images derived from the GSI scans. The training and testing sets were randomly assigned in a 7:3 ratio. All cases were divided into groups distinguishing the injury time at 30 and 90 days. We constructed radiomics-based models to predict the injury time of rib fractures. The model performance was assessed by the area under the curve (AUC) obtained by the receiver operating characteristic analysis. We included 54 patients with 259 rib fracture segmentations (34 men; mean age, 52 years ± 12.02; and range, 19-72 years). Nine features were excluded by the least absolute shrinkage and selection operator logistic regression to build the radiomics signature. For distinguishing the injury time at 30 days, the Support Vector Machine (SVM) model and human-model collaboration resulted in an accuracy and AUC of 0.85 and 0.871 and 0.91 and 0.912, respectively, and 0.81 and 0.804 and 0.83 and 0.85, respectively, at 90 days in the testing set. The radiomics-based model displayed good accuracy in differentiating between the injury time of rib fractures at 30 and 90 days, and the human-model collaboration generated more accurate outcomes, which may help to add value to clinical practice and distinguish artificial injury in forensic medicine.
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Kring RM, Mackenzie DC, Wilson CN, Rappold JF, Strout TD, Croft PE. Ultrasound-Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. J Ultrasound Med 2022; 41:2695-2701. [PMID: 35106815 DOI: 10.1002/jum.15953] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The serratus anterior plane block (SAPB) is an ultrasound-guided compartment block; limited data suggest that it can decrease pain in patients with rib fractures or chest wall pain. We sought to determine the effect of SAPB on pain and incentive spirometry (IS) maximal vital capacity in adult patients with rib fractures. METHODS We enrolled a prospective sample of adult patients with at least two unilateral rib fractures who were being admitted for pain control. SAPB was performed by trained emergency physicians. Patients reported pain on an 11-point Numeric Rating Scale at rest and during IS, before, 15, and 60 minutes after SAPB. RESULTS Mean pain scores decreased by 1.8 (SD 2.17, 95% confidence interval [CI]: 0.79-2.81) at 15 minutes and 2.5 (SD 2.69, 95% CI: 1.24-3.76) at 60 minutes. Compared to pre-block pain scores during IS, mean pain scores decreased by 1.95 (SD 1.99, 95% CI: 1.02-2.88) at 15 minutes and 2.4 (SD 2.42, 95% CI: 1.27-3.53) at 60 minutes. Mean maximum vital capacity increased by 232 mL (SD 406, 95% CI: 36-427) at 60 minutes. Zero SAPB-attributable complications were identified in the 24 hours post-enrollment. CONCLUSIONS In patients with multiple rib fractures, SAPB reduced pain scores at rest and during IS, and increased maximal vital capacity. The SABP may be a safe and effective modality for pain control in trauma patients with multiple rib fractures.
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Affiliation(s)
- Randy M Kring
- Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA
| | - David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA
| | - Christina N Wilson
- Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA
| | - Joseph F Rappold
- Department of Surgery, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA
| | - Tania D Strout
- Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA
| | - Peter E Croft
- Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA
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Yurtsever G, Yamanoglu A, Bora ES, Topal FE. A rare complication of cardiopulmonary resuscitation applied during transportation by ambulance: A case report of flail chest. Turk J Emerg Med 2022; 22:159-162. [PMID: 35936949 PMCID: PMC9355074 DOI: 10.4103/2452-2473.348437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/29/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) to be applied during patient transfer by ambulance differs from CPR applied in the field or in the hospital in terms of physical condition. Especially the deeper and faster chest compressions recommended in the latest CPR guidelines, when administered during ambulance transport, may result in a further increase in traumatic CPR complications. However, in the current CPR guidelines, there are no clear recommendations regarding additional measures that can be taken to reduce the complications and increase the efficiency of CPR during patient transport. In this study, a case of flail chest that developed after short-term CPR application during ambulance transport is presented. The aim of this study was to evaluate the flail chest complication and solution suggestions that may occur due to chest compressions applied during transportation.
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Affiliation(s)
- Güner Yurtsever
- Department of Emergency Medicine, Izmir Kâtip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Adnan Yamanoglu
- Department of Emergency Medicine, Izmir Kâtip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ejder Saylav Bora
- Department of Emergency Medicine, Izmir Kâtip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fatih Esad Topal
- Department of Emergency Medicine, Izmir Kâtip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
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Kheirbek T, Martin TJ, Cao J, Tillman AC, Spivak HA, Heffernan DS, Lueckel SN. Comparison of Infectious Complications after Surgical Fixation versus Epidural Analgesia for Acute Rib Fractures. Surg Infect (Larchmt) 2022; 23:532-537. [PMID: 35766917 DOI: 10.1089/sur.2022.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical stabilization of rib fractures (SSRF) is associated with decreased mortality and respiratory complications. Patients who are not offered SSRF are often treated with epidural analgesia (EA) to reduce pain and improve pulmonary mechanics. We sought to compare infectious complications in patients undergoing either SSRF or EA. We hypothesized that infectious complications are equivalent between the two treatment groups. Patients and Methods: We performed a retrospective cohort study of adult trauma patients with acute rib fractures within the Trauma Quality Improvement Program (TQIP) 2017 dataset and used International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify patients who underwent SSRF or EA. We excluded patients who received both treatments in the same admission. Our primary outcome was the development of sepsis. Secondary outcomes were specific infections including ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central line-associated blood stream infections (CLABSI). Multiple logistic regression analyses were used to adjust for age, injury severity score (ISS), chest Abbreviated Injury Scale (AIS), flail chest, traumatic brain injury (TBI), and comorbidities. Results: We identified 2,252 and 1,299 patients who underwent SSRF and EA, respectively. Patients with SSRF were younger with higher ISS and longer length of stay (LOS). There was no difference in mortality, however, SSRF had higher rate of sepsis (1.6% vs. 0.5%; p = 0.001), VAP (5.1% vs. 0.9%; p < 0.001), CAUTI (1.7% vs. 0.5%; p = 0.001), and CLABSI (0.2% vs. 0%; p = 0.05). On multiple regression, SSRF was associated with higher odds of sepsis (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.04-6.63), CAUTI (OR, 2.96; 95% CI, 1.11-7.88), and VAP (OR, 3.24; 95% CI, 1.73-6.06). Among those who developed sepsis, there was no significant difference in mortality or LOS between groups. Conclusions: Despite no difference in mortality, SSRF was associated with increased risk of septic complications in patients with rib fractures compared to epidural analgesia. Identifying, and addressing, risk factors of sepsis in this patient population is a critical performance improvement process to optimize outcomes without increased adverse events.
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Affiliation(s)
- Tareq Kheirbek
- Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA
| | - Thomas J Martin
- Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA
| | - Jessica Cao
- Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA
| | - Anastasia C Tillman
- Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA
| | - Holden A Spivak
- Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA
| | - Daithi S Heffernan
- Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA
| | - Stephanie N Lueckel
- Brown University, Alpert Medical School, Department of Surgery, Providence, Rhode Island, USA
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Reindl S, Jawny P, Girdauskas E, Raab S. Is it Necessary to Stabilize Every Fracture in Patients with Serial Rib Fractures in Blunt Force Trauma? Front Surg 2022; 9:845494. [PMID: 35756475 PMCID: PMC9218347 DOI: 10.3389/fsurg.2022.845494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Management of traumatic rib fractures is subject of controversial discussions. Rib fractures are common, especially after traffic accidents and falls. There is no consensus on whether and how many rib fractures need reconstruction. Not every rib fracture needs to be stabilized, but conservative treatment by internal splinting and analgesia is not effective for all patients. Deformities of the chest wall with reduced thoracic volume and restrictive ventilation disorders must be avoided. Intraoperative assessment of fractures and chest stability plays a central role. Material and methods From 07/2016 to 07/2021, a total of 121 chest wall stabilizations were performed (m:f = 2:1, age 65 ± 14.5 a). Indications for surgery were the following criteria: (1) palpatory instability of the chest wall, (2) dislocated fracture endings, (3) concomitant injuries, (4) uncontrollable pain symptoms. In all patients, a computed tomography scan of the thorax was performed before the osteosynthetic treatment to assess dislocation of the fracture endings and possible concomitant injuries of intrathoracic organs. Results Video-assisted thoracoscopy was performed in all patients. Hemothorax and concomitant injuries of the lung, diaphragm and mediastinum could be assessed. This was followed by an intraoperative assessment of the rib fractures, in particular penetration of fracture endings and resulting instability and deformity. Relevant fractures could be identified and subsequent incisions for rib osteosynthesis precisely defined. 6.3 (±2.7) rib fractures were detected, but 2.4 (±1.2) ribs treated osteosynthetically. Bilateral rib fractures were present in 26 patients (21.5%). Post-operative bleeding occurred in seven patients (5.8%), a breakage of the osteosynthetic material in two patients (1.7%). Discussion Intraoperative assessment of relevant fractures and dislocation is the decisive criterium for osteosynthesis. Thoracoscopy is mandatory for this purpose - also to identify accompanying injuries. Not every fracture has to be approached osteosynthetically. Even with serial rib fractures or multiple fractures in a single rib, the thoracic contour can be restored by stabilizing only relevant fractures. Intraoperative palpation can adequately assess the stability and thus the result of the osteosynthesis. Even after surgical treatment of thoracic trauma, adequate analgesia and respiratory therapy are important to the healing process.
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Affiliation(s)
- Sebastian Reindl
- Department for Cardiothoracic Surgery, Medical Faculty, University Hospital Augsburg, Augsburg, Germany
| | - Philipp Jawny
- Department for Cardiothoracic Surgery, Medical Faculty, University Hospital Augsburg, Augsburg, Germany
| | - Evaldas Girdauskas
- Department for Cardiothoracic Surgery, Medical Faculty, University Hospital Augsburg, Augsburg, Germany
| | - Stephan Raab
- Department for Cardiothoracic Surgery, Medical Faculty, University Hospital Augsburg, Augsburg, Germany
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Forrester JD, Bukur M, Dvorak JE, Faliks B, Hindin D, Kartiko S, Kheirbek T, Lin L, Manasa M, Martin TJ, Miskimins R, Patel B, Pieracci FM, Ritter KA, Schubl SD, Tung J, Huston JM. Surgical Infection Society: Chest Wall Injury Society Recommendations for Antibiotic Use during Surgical Stabilization of Traumatic Rib or Sternal Fractures to Reduce Risk of Implant Infection. Surg Infect (Larchmt) 2022; 23:321-331. [PMID: 35522129 DOI: 10.1089/sur.2022.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Surgical stabilization of rib fractures is recommended in patients with flail chest or multiple displaced rib fractures with physiologic compromise. Surgical stabilization of rib fractures (SSRF) and surgical stabilization of sternal fractures (SSSF) involve open reduction and internal fixation of fractures with a plate construct to restore anatomic alignment. Most plate constructs are composed of titanium and presence of this foreign, non-absorbable material presents opportunity for implant infection. Although implant infection rates after SSRF and SSSF are low, they present a challenging clinical entity often requiring prolonged antibiotic therapy, debridement, and potentially implant removal. Methods: The Surgical Infection Society's Therapeutics and Guidelines Committee and Chest Wall Injury Society's Publication Committee convened to develop recommendations for antibiotic use during and after surgical stabilization of traumatic rib and sternal fractures. Clinical scenarios included patients with concomitant infectious processes (sepsis, pneumonia, empyema, cellulitis) or sources of contamination (open chest, gross contamination) incurred as a result of their trauma and present at the time of their surgical stabilization. PubMed, Embase, and Cochrane databases were searched for pertinent studies. Using a process of iterative consensus, all committee members voted to accept or reject each recommendation. Results: For patients undergoing SSRF or SSSF in the absence of pre-existing infectious process, there is insufficient evidence to suggest existing peri-operative guidelines or recommendations are inadequate. For patients undergoing SSRF or SSSF in the presence of sepsis, pneumonia, or an empyema, there is insufficient evidence to provide recommendations on duration and choice of antibiotic. This decision may be informed by existing guidelines for the concomitant infection. For patients undergoing SSRF or SSSF with an open or contaminated chest there is insufficient evidence to provide specific antibiotic recommendations. Conclusions: This guideline document summarizes the current Surgical Infection Society and Chest Wall Injury Society recommendations regarding antibiotic use during and after surgical stabilization of traumatic rib or sternal fractures. Limited evidence exists in the chest wall surgical stabilization literature and further studies should be performed to delineate risk of implant infection among patients undergoing SSSRF or SSSF with concomitant infectious processes.
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Affiliation(s)
- Joseph D Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Marko Bukur
- Division of Acute Care Surgery, Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Justin E Dvorak
- Division of Trauma, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Bradley Faliks
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - David Hindin
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Susan Kartiko
- Center for Trauma and Critical Care, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Tareq Kheirbek
- Department of Surgery, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Leo Lin
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Morgan Manasa
- Department of General Surgery, University of California, Irvine, Irvine, California, USA
| | - Thomas J Martin
- Department of Surgery, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Richard Miskimins
- Division of Acute Care Surgery, Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Bhavik Patel
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Fredric M Pieracci
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
| | - Kaitlin A Ritter
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
| | - Sebastian D Schubl
- Department of General Surgery, University of California, Irvine, Irvine, California, USA
| | - Jamie Tung
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Jared M Huston
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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D'Errico C, Sellini M, Cafiero T, Romano GM, Frangiosa A. Successful weaning from mechanical ventilation after Serratus Anterior Plane block in a chest trauma patient. Scand J Pain 2022; 22:417-420. [PMID: 34648699 DOI: 10.1515/sjpain-2021-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Chest trauma is associated with severe pain, which can hamper normal breathing. Serratus Anterior Plane block (SAPB) is a novel technique, which provides analgesia for chest wall surgery. We describe an interesting clinical case about the use of SAPB to improve pain and pulmonary function in a patient with severe chest trauma. CASE PRESENTATION We report the pain management and the clinical evolution of a patient in ICU, with a severe chest trauma, after performing the SAPB. Following the SAPB, the patient had a reduction in pain intensity and an improvement in both respiratory mechanics and blood gas analysis allowing a weaning from mechanical ventilator. CONCLUSIONS Pain control greatly affects mortality and morbidity in patients with chest trauma. SAPB seems to be safer and equally effective in pain control compared to epidural analgesia in patients with chest trauma.
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Affiliation(s)
- Cristiano D'Errico
- Department of Anesthesia and Intensive Care Unit, AORN Cardarelli, Naples, Italy
| | - Manuela Sellini
- Department of Anesthesia and Intensive Care Unit, AORN Cardarelli, Naples, Italy
| | - Tullio Cafiero
- Department of Anesthesia and Intensive Care Unit, AORN Cardarelli, Naples, Italy
| | | | - Antonio Frangiosa
- Department of Anesthesia and Intensive Care Unit, AORN Cardarelli, Naples, Italy
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Kushniruk A, Banks A, Melton GB, Porta CM, Tignanelli CJ. Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System-Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses. JMIR Hum Factors 2022; 9:e29019. [PMID: 35293873 PMCID: PMC8968578 DOI: 10.2196/29019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 11/04/2021] [Accepted: 12/19/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance. OBJECTIVE This study aims to characterize factors influencing successful design and use of comprehensive CDS care maps and identify themes associated with end-user acceptance of a thoracic trauma CDS care map earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Design development and implementation strategy for a CDS care map. This stage was based on a previously developed prototype CDS care map guided by the Unified Theory of Acceptance and Use of Technology. METHODS A total of 22 multidisciplinary end users (physicians, advanced practice providers, and nurses) were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio-recorded, and transcribed verbatim. Generation of prespecified codes and the interview guide was informed by the Unified Theory of Acceptance and Use of Technology constructs and investigative team experience. Interviews were blinded and double-coded. Thematic analysis of interview scripts was conducted and yielded descriptive themes about factors influencing the construction and potential use of an acceptable CDS care map. RESULTS A total of eight dominant themes were identified: alert fatigue (theme 1), automation (theme 2), redundancy (theme 3), minimalistic design (theme 4), evidence based (theme 5), prevent errors (theme 6), comprehensive across the spectrum of disease (theme 7), and malleability (theme 8). Themes 1 to 4 addressed factors directly affecting end users, and themes 5 to 8 addressed factors affecting patient outcomes. More experienced providers prioritized a system that is easy to use. Nurses prioritized a system that incorporated evidence into decision support. Clinicians across specialties, roles, and ages agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently. CONCLUSIONS End user feedback reinforces attention toward factors that improve the acceptance and use of a CDS care map for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and optimal care provision. Identifying these factors early in the development and implementation process may facilitate user-centered design and improve adoption.
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Affiliation(s)
| | - Alyssa Banks
- University of Minnesota, Minneapolis, MN, United States
| | - Genevieve B Melton
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Christopher J Tignanelli
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States.,Department of Surgery, North Memorial Health Hospital, Robbinsdale, MN, United States
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Agrafiotis AC, Bourlon L, Etienne H, Le Roux M, Mazzoni L, Giol M, Debrosse D, Assouad J. Is surgical rib fixation in patients aged more than 65 years old associated with worse outcomes compared to younger patients? A retrospective single-center study. Acta Chir Belg 2022; 122:35-40. [PMID: 33146583 DOI: 10.1080/00015458.2020.1846939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is no robust data regarding rib fixation in elderly patients. The aim of this study is to compare the postoperative outcomes of patients aged less and more than 65 years old. METHODS Patients operated from January 2012 to December 2018 were retrospectively analyzed. The following data were collected: age, sex, comorbidities, smoking habit, Injury Severity Score (ISS), number of fractured ribs, indication for surgery, associated injuries, time from trauma to surgery, number of fixed ribs, intrathoracic injuries, duration of intubation, ICU stay, postoperative cardiopulmonary complications, blood transfusion, overall and 30-day mortality, length of stay. RESULTS There was no difference regarding the ISS (p = 0.09), the number of rib fractures (p = 0.291), the indication for surgery, the number of fixed ribs (p = 0.819), the ICU stay (p = 0.096), the postoperative intubation duration (p = 0.059), the cardiopulmonary complications (p = 0.273) and perioperative blood transfusions (p = 0.34). Elderly patients presented more postoperative cognitive complications (p < 0.001). There was no difference in terms of overall mortality (p = 0.06) and 30-day mortality (p = 0.69). Elderly patients stayed longer in the hospital (p < 0.001). CONCLUSIONS The outcomes of rib fixation in the elderly patients are comparable to younger patients. However, elderly patients experience more frequently postoperative cognitive complications and their hospitalizations are longer.
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Affiliation(s)
| | - Lucie Bourlon
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Marielle Le Roux
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Lucia Mazzoni
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Mihaela Giol
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Denis Debrosse
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
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