Heterogeneity in managing rib fractures across non-trauma and level I, II, and III trauma centers - 16/09/21
, Aydin Kaghazchi b, c, Katherine L. Dickerson c, d, Lakshika Tennakoon a, c, David A. Spain a, c, Joseph D. Forrester a, cAbstract |
Background |
We aimed to elucidate management patterns and outcomes of high-risk patients with rib fractures (elderly or flail chest) across non-trauma and trauma centers. We hypothesized highest-capacity (level I) centers would have best outcomes for high-risk patients.
Methods |
We queried the 2016 National Emergency Department Sample to identify adults presenting with rib fractures. Multivariable regression assessed ED and inpatient events across non-trauma and level III/II/I trauma centers.
Results |
Among 504,085 rib fracture encounters, 46% presented to non-trauma centers. Elderly patients with multiple rib fractures had stepwise increase in inpatient admission odds and stepwise decrease in pneumonia odds at higher-capacity trauma centers compared to non-trauma centers. Among patients with flail chest, odds of undergoing surgical stabilization (SSRF) increased at trauma centers. Undergoing SSRF was associated with reduced mortality but remained underutilized.
Conclusion |
Half of patients with rib fractures present to non-trauma centers. Nationwide care-optimization for high-risk patients requires further effort.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Nearly half of US adults with traumatic rib fractures present to non-trauma centers. |
• | Higher capacity centers had stepwise increase in admitting high-risk patients. |
• | Higher capacity centers had stepwise increase in surgically stabilizing flail chest. |
• | Patients with flail chest may warrant timely transfer to centers that perform SSRF. |
• | Wider dissemination of best rib fracture management practices is needed. |
Keywords : Rib fractures, Trauma systems, Emergency department, Surgical stabilization of rib fractures
Plan
Vol 222 - N° 4
P. 849-854 - octobre 2021 Retour au numéro
Article précédent
- Sex differences in long-term outcomes after traumatic injury: A mediation analysis
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