A comprehensive analysis of traumatic rib fractures in an acute general hospital in Singapore

Autor:	Woan Wui Lim, Min Li Kang, A K Ishara Maduka, Kumaresh Venkatesan, George J Lin, Jerry Goo Tiong Thye, Daniel Jin Keat Lee, Ming Hui Wong
Rok vydání:	2019
Předmět:	Thorax medicine.medical_specialty Flail chest Asia medicine.medical_treatment 030204 cardiovascular system & hematology flail chest law.invention 03 medical and health sciences 0302 clinical medicine law Fraction of inspired oxygen medicine Mechanical ventilation emergency business.industry lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 Hemothorax medicine.disease Intensive care unit Surgery trauma Pneumothorax rib fracture Emergency Medicine Injury Severity Score Original Article business
Zdroj:	Journal of Emergencies, Trauma and Shock, Vol 12, Iss 2, Pp 145-149 (2019) Journal of Emergencies, Trauma, and Shock
ISSN:	0974-2700
DOI:	10.4103/jets.jets_72_18
Popis:	Background: Rib fractures are common sequelae after blunt chest wall trauma. They can occur in isolation or association with life-threatening injuries to the head, thorax, and abdomen and may be complicated by hemothorax, pneumothorax, or lung contusions. Contiguous rib fractures can result in flail chest, which is associated with increased morbidity and mortality. This study aims to compare the risk factors, treatment modalities, and outcomes between patients with flail chest and nonflail chest postblunt trauma. Patients and Methods: Data were retrospectively collected from all patients admitted with rib fractures from January 2016 to December 2016 to the Department of General Surgery, Khoo Teck Puat Hospital, Singapore. The outcomes identified were mortality, pain scores on injury day 1, 3, 5, and 7, injury severity score, duration of mechanical ventilation, worst partial pressure arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, length of intensive care unit (ICU) stay, and pulmonary complications. Results: Motor vehicle accident was the most common cause of rib fractures (63.1%, n = 123). Patients with flail chest had more associated pneumothorax (53.8% vs. 35.2%) and lung contusions (53.8% vs. 30.2%) compared to those without flail chest and underwent more investigations such as inpatient-computed tomography scans (76.9% vs. 59.3%), interventions such as chest tube insertion (61.5% vs. 19.8%), and ICU admission (46.1 vs. 13.7%). Patients also had higher pain scores, used more analgesic modalities, and had increased inpatient mortality (30.8% vs. 4.4%). Conclusion: Flail chest is associated with higher morbidity and mortality. Proactive management from a multidisciplinary team such as identification of high-risk patients in particular patients with flail chest, early admission to critical care, and protocols including multimodal pain management, respiratory support, and rehabilitation should be instituted.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::872481bc9e337414b6e2b2259b94a5d5 https://doi.org/10.4103/jets.jets_72_18 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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