Abstract
Purpose
Surgical Stabilization (SSRF) is gaining popularity as an alternative to non-operative management (NOM) of patients with rib fractures, however, there are no established guidelines for patients’ quantifiable evaluation and for SSRF recommendation. Known rib scoring systems include: Rib Fracture Score (RFS), Chest Wall Trauma Score (CWTS), Chest Trauma Score (CTS) and RibScore (RS), but are underutilized. The purpose was to provide values of scoring systems in SSRF and NOM patients and correlate them with treatment assignment.
Methods
Retrospective cohort study included 87 SSRF and 87 propensity matched NOM patients from two level-1 trauma centers. Clinical variables and score values were compared between two groups.
Results
SSRF compared to NOM patients had significantly higher number of total rib fractures, displaced fractures, rates of pulmonary contusion and flail chest. RS and CTS values were significantly higher in SSRF compared to NOM patients (2.3 vs. 1.7, p = 0.001; 5.8 vs. 5.3, p = 0.005, respectively), but RFS and CWTS were similar.
Conclusions
Application of scoring systems could help with patients’ objective and standardized assessment and may aid in treatment decisions. RibScore was superior to other scoring systems.
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References
Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg. 2003;23(3):374–8.
de Moya M, Nirula R, Biffl W. Rib fixation: Who, What, When? Trauma Surg Acute Care Open. 2017;2:1–4.
Kane ED, Jeremitsky E, Pieracci FM, Majercik S, Doben AR. Quantifying and exploring the recent national increase in surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2017;83(6):1047–52.
Dehghan N, Mah JM, Schemitsch EH, Nauth A, Vicente M, McKee MD. Operative stabilization of flail chest injuries reduces mortality of that of stable chest wall injuries. J Orthop Trauma. 2018;32(1):15–21.
Lafferty PM, Anavian J, Will RE, Cole PA. Operative treatment of chest wall injuries: indications, technique, and outcomes. J Bone Joint Surg Am. 2011;93(1):97–110.
Fowler TT, Taylor BC, Bellino MJ, Althausen PL. Surgical treatment of flail chest and rib fractures. J Am Acad Orthop Surg. 2014;22(12):751–60.
Sarani B, Schulte L, Diaz JJ. Pitfalls associated with open reduction and internal fixation of fractured ribs. Injury. 2015;46(12):2335–40.
Senekjian L, Nirula R. Rib fracture fixation: indications and outcomes. Crit Care Clin. 2017;33(1):153–65.
Fitzgerald MT, Ashley DW, Abukhdeir H, Christie DB III. Rib fracture fixation in the 65 years and older population: a paradigm shift in management strategy at a Level I trauma center. J Trauma Acute Care Surg. 2017;82(3):524–27.
Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618–26.
Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001;10(5):320–7.
Pressley CM, Fry WR, Philp AS, Berry SD, Smith RS. Predicting outcome of patients with chest wall injury. Am J Surg. 2012;204(6):910–3.
Chen J, Jeremitsky E, Philp F, Fry W, Smith RS. A chest trauma scoring system to predict outcomes. Surgery. 2014;156(4):988–93.
Chapman BC, Herbert B, Rodil M, et al. RibScore: a novel radiographic score based on fracture pattern that predicts pneumonia, respiratory failure, and tracheostomy. J Trauma Acute Care Surg. 2016;80(1):95–101.
Pieracci FM, Lin Y, Rodil M, et al. A prospective, controlled clinical evaluation of surgical stabilization of severe rib fractures. J Trauma Acute Care Surg. 2016;80(2):187–94.
Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res. 2011;46(3):399–424.
Maxwell CA, Mion LC, Dietrich MS. Hospitalized injured older adults: clinical utility of a rib fracture scoring system. J Trauma Nurs. 2012;19(3):168–74.
Taylor BC, Fowler TT, French BG, Domininguez N. Clinical outcomes of surgical stabilization of flail chest injury. J Am Acad Orthop Surg. 2016;24:575–80.
Schulz-Drost S, Krinner S, Langenbach A, et al. Concomitant sternal fracture in flail chest: an analysis of 21,741 polytrauma patients from the TraumaRegister DGU®. Thorac Cardiovasc Surg. 2017;65(7):551–9.
Langenbach A, Pinther M, Krinner S, et al. Surgical stabilization of costoclavicular injuries—a combination of flail chest injuries and a clavicula fracture. Chirurgia (Bucur). 2017;112(5):595–606.
Watkins R IV, Watkins R III, Williams L, et al. Stability provided by the sternum and rib cage in the thoracic spine. Spine. 2005;30(11):1283–6.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Authors Joanna Wycech, Alexander Fokin, Ivan Puente declare that they have no conflict of interest.
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This retrospective cohort (Trauma Registry) study was approved by IRB and the waiver of informed consent was granted.
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Wycech, J., Fokin, A.A. & Puente, I. Evaluation of patients with surgically stabilized rib fractures by different scoring systems. Eur J Trauma Emerg Surg 46, 441–445 (2020). https://doi.org/10.1007/s00068-018-0999-3
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DOI: https://doi.org/10.1007/s00068-018-0999-3