Tracheostomy in trauma patients with rib fractures
Patients with rib fractures (RF) may require prolonged mechanical ventilation and tracheostomy. Indications for tracheostomy in trauma patients with RF remain debatable. The goal was to delineate characteristics of patients who underwent tracheostomy due to thoracic versus extra-thoracic causes, such as maxillofacial–mandibular injury (MFM), traumatic brain injury (TBI), and cervical vertebrae trauma (CVT), and to analyze clinical outcomes. The predictive values of chest trauma scoring systems for tracheostomy were also evaluated. We hypothesized that tracheostomized patients were more severely injured with more ribs fractured and had more pulmonary co-injuries.
Retrospective review included 471 patients with RF admitted to two Level 1 trauma centers. Patients with tracheostomy (n = 124, 26.3%) were compared to patients with endotracheal intubation (n = 347, 73.7%). Analyzed variables included age, gender, injury severity score (ISS), Glasgow Coma Scale, number of ribs fractured, total fractures of ribs, prevalence of bilateral rib fractures, flail chest, clavicle fractures, MFM, TBI, CVT, co-injuries, comorbidities, RF treatment options, hospital length of stay (HLOS), intensive care unit LOS (ICULOS), duration of mechanical ventilation (DMV).
Tracheostomized compared to intubated patients had statistically higher ISS, more ribs fractured, total fractures of the ribs, bilateral and clavicle fractures, MFM, spine, chest, and orthopedic co-injuries and longer HLOS, ICULOS and DMV. Tracheostomy for thoracic reasons was performed in 64 patients (51.6%) and for extra-thoracic reasons in 60 patients (48.4%). Mean tracheostomy timing was 9.9 days and was significantly shorter in the extra-thoracic compared to the thoracic group (8.0 versus 11.6 days, p < 0.001). All chest trauma scoring system values were significantly higher in tracheostomized patients. Predictive values of scoring systems for tracheostomy increased in patients with thoracic trauma only.
A quarter of mechanically ventilated patients with RF required tracheostomy. Tracheostomized compared to intubated patients were more severely injured with more ribs fractured and were intubated longer. An increased amount of RF was associated with an increase in tracheostomies, especially for thoracic reasons.
KeywordsTracheostomy Rib fractures Chest trauma Rib fracture scoring systems
Compliance with ethical standards
Conflict of interest
Author Alexander Fokin, Author Joanna Wycech, Author Kyle Chin Shue, Author Ryan Stalder, Author Jose Lozada, and Author Ivan Puente declare that they have no conflict of interest.
This manuscript has not been published previously or submitted elsewhere for publication and will not be sent to another journal until a decision is made concerning publication by the European Journal of Trauma and Emergency Surgery.
This retrospective cohort study was approved by IRB. All procedures performed in the study involving human participants were in compliance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
The waiver of informed consent was granted by IRB.
- 12.Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001;10(5):320–7.Google Scholar
- 23.Fokin AA, Wycech J, Weisz R, Puente I. Outcome analysis of surgical stabilization of rib fractures in trauma patients. J Orthop Trauma. 2019;33(1):3–8.Google Scholar