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Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury.
Prins, Jonne T H; Van Lieshout, Esther M M; Ali-Osman, Francis; Bauman, Zachary M; Caragounis, Eva-Corina; Choi, Jeff; Christie, D Benjamin; Cole, Peter A; DeVoe, William B; Doben, Andrew R; Eriksson, Evert A; Forrester, Joseph D; Fraser, Douglas R; Gontarz, Brendan; Hardman, Claire; Hyatt, Daniel G; Kaye, Adam J; Ko, Huan-Jang; Leasia, Kiara N; Leon, Stuart; Marasco, Silvana F; McNickle, Allison G; Nowack, Timothy; Ogunleye, Temi D; Priya, Prakash; Richman, Aaron P; Schlanser, Victoria; Semon, Gregory R; Su, Ying-Hao; Verhofstad, Michael H J; Whitis, Julie; Pieracci, Fredric M; Wijffels, Mathieu M E.
Afiliación
  • Prins JTH; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
  • Van Lieshout EMM; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
  • Ali-Osman F; Department of Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, 85020, USA.
  • Bauman ZM; Division of Trauma, Emergency General Surgery, Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA.
  • Caragounis EC; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • Choi J; Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, CA, 94305, USA.
  • Christie DB; Department of Trauma Surgery/Critical Care, Mercer University School of Medicine, The Medical Center Navicent Health, Macon, GA, 31201, USA.
  • Cole PA; HealthPartners Orthopedics and Sports Medicine, Bloomington, MN, 55420, USA.
  • DeVoe WB; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, 55455, USA.
  • Doben AR; Department of Orthopaedic Surgery, Regions Hospital, Saint Paul, MN, 55101, USA.
  • Eriksson EA; Department of Surgery, Riverside Methodist Hospital, Columbus, 43214 OH, USA.
  • Forrester JD; Department of Surgery, Saint Francis Hospital, Hartford, CT, 06105, USA.
  • Fraser DR; Division of Trauma and Critical Care, Department of Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA.
  • Gontarz B; Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, CA, 94305, USA.
  • Hardman C; Department of Surgery, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, 89102, USA.
  • Hyatt DG; Department of Surgery, Saint Francis Hospital, Hartford, CT, 06105, USA.
  • Kaye AJ; Division of Trauma, Department of Surgery, Wright State University/Miami Valley Hospital, Dayton, OH, 45409, USA.
  • Ko HJ; Department of Surgery, Riverside Methodist Hospital, Columbus, 43214 OH, USA.
  • Leasia KN; Department of Surgery, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA.
  • Leon S; Division of Trauma Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, 30059, Taiwan.
  • Marasco SF; Department of Surgery, Denver Health Medical Center, Denver, CO, 80204, USA.
  • McNickle AG; Division of Trauma and Critical Care, Department of Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA.
  • Nowack T; CJOB Department of Cardiothoracic Surgery, The Alfred, Melbourne, Australia.
  • Ogunleye TD; Department of Surgery, Monash University, Clayton, VIC, Australia.
  • Priya P; Department of Surgery, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, 89102, USA.
  • Richman AP; Department of Trauma Surgery/Critical Care, Mercer University School of Medicine, The Medical Center Navicent Health, Macon, GA, 31201, USA.
  • Schlanser V; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, 55455, USA.
  • Semon GR; Department of Orthopaedic Surgery, Regions Hospital, Saint Paul, MN, 55101, USA.
  • Su YH; Department of Surgery, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA.
  • Verhofstad MHJ; Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
  • Whitis J; Department of Trauma/Burn, John H Stroger Hospital of Cook County, Chicago, IL, 60612, USA.
  • Pieracci FM; Division of Trauma, Department of Surgery, Wright State University/Miami Valley Hospital, Dayton, OH, 45409, USA.
  • Wijffels MME; Division of Trauma Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, 30059, Taiwan.
Eur J Trauma Emerg Surg ; 48(4): 3327-3338, 2022 Aug.
Article en En | MEDLINE | ID: mdl-35192003
ABSTRACT

PURPOSE:

Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale ≤ 12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients.

METHODS:

A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. The primary outcome was mechanical ventilation-free days and secondary outcomes were in-hospital outcomes. In multivariable analysis, outcomes were assessed, stratified for rib fracture pattern.

RESULTS:

In total, 449 patients were analyzed. In patients with a non-flail fracture pattern, 25 of 228 (11.0%) underwent SSRF and in patients with a flail chest, 86 of 221 (38.9%). In multivariable analysis, ventilator-free days were similar in both treatment groups. For patients with a non-flail fracture pattern, the odds of pneumonia were significantly lower after SSRF (odds ratio 0.29; 95% CI 0.11-0.77; p = 0.013). In patients with a flail chest, the ICU LOS was significantly shorter in the SSRF group (beta, - 2.96 days; 95% CI - 5.70 to - 0.23; p = 0.034).

CONCLUSION:

In patients with TBI and a non-flail fracture pattern, SSRF was associated with a reduced pneumonia risk. In patients with TBI and a flail chest, a shorter ICU LOS was observed in the SSRF group. In both groups, SSRF was safe and did not hamper neurological recovery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 4_TD Problema de salud: 4_pneumonia Asunto principal: Neumonía / Fracturas de las Costillas / Tórax Paradójico / Lesiones Traumáticas del Encéfalo Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Eur J Trauma Emerg Surg Año: 2022 Tipo del documento: Article País de afiliación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 4_TD Problema de salud: 4_pneumonia Asunto principal: Neumonía / Fracturas de las Costillas / Tórax Paradójico / Lesiones Traumáticas del Encéfalo Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Eur J Trauma Emerg Surg Año: 2022 Tipo del documento: Article País de afiliación: Países Bajos