Routine 6-Week Outpatient Radiography and Visit in Patients with Conservatively Treated Multiple Rib Fractures: Valuable or a Waste of Resources?

Autor:	Peuker F; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.; Department of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland., Bosch TP; Department of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.; Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands., Houwert RM; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Hoepelman RJ; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Niemeyer MJS; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., van Baal M; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Minervini F; Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland., Beeres FJP; Department of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland., van de Wall BJM; Department of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Jazyk:	angličtina
Zdroj:	Journal of chest surgery [J Chest Surg] 2024 Sep 05; Vol. 57 (5), pp. 430-439. Date of Electronic Publication: 2024 Apr 11.
DOI:	10.5090/jcs.23.134
Abstrakt:	Background: This study investigated the incidence and clinical consequences of abnormal radiological and clinical findings during routinely performed 6-week outpatient visits in patients treated conservatively for multiple (3 or more) rib fractures. Methods: A retrospective analysis was conducted among patients with multiple rib fractures treated conservatively between 2018 and 2021 (Opvent database). The primary outcome was the incidence of abnormalities on chest X-ray (CXR) and their clinical consequences, which were categorized as requiring intervention or additional clinical/radiological examination. The secondary focus was the incidence of deviation from standard treatment in response to the findings (clinical or radiological) at the routine 6-week outpatient visit. Results: In total, 364 patients were included, of whom 246 had a 6-week visit with CXR. The median age was 57 years (interquartile range, 46-70 years) and the median Injury Severity Score was 17 (interquartile range, 13-22). Forty-six abnormalities (18.7%) were found on CXR. These abnormalities resulted in additional outpatient visits in 4 patients (1.5%) and in chest drain insertion in 2 (0.8%). Only 2 patients (0.8%) with an abnormality on CXR presented without symptoms. None of the 118 patients who had visits without CXR experienced problems. Conclusion: Routine 6-week outpatient visits for patients with conservatively treated multiple rib fractures infrequently revealed abnormalities requiring treatment modifications. It may be questioned whether the 6-week outpatient visit is even necessary. Instead, a more targeted approach could be adopted, providing follow-up to high-risk or high-demand patients only, or offering guidance on recognizing warning signs and providing aftercare through a smartphone application.
Databáze:	MEDLINE
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