Rib fixation versus non-operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: a multicenter cohort study.
Background: Over the years, a trend has evolved towards operative treatment of flail chest although evidence is limited. Furthermore, little is known about operative treatment for patients with multiple rib fractures without a flail chest. The aim of this study was to compare rib fixation based on a...
| Publicado en: | European Journal of Trauma & Emergency Surgery Vol. 45; no. 4; pp. 655 - 664 |
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| Autores principales: | , , , , , , , , |
| Formato: | algorithm research tables/charts Journal Article |
| Publicado: |
Springer Nature
Aug2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=137992055&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 137992055 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18639933 3C05 jtl: European Journal of Trauma & Emergency Surgery issn: 18639933 maglogo: N pubinfo: dt: Aug2019 vid: 45 iid: 4 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 137992055 137992055 137992055 10.1007/s00068-018-1037-1 137992055 ppf: 655 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Rib fixation versus non-operative treatment for flail chest and multiple rib fractures after blunt thoracic trauma: a multicenter cohort study. aug: au: Beks, Reinier B. Reetz, David de Jong, Mirjam B. Groenwold, Rolf H. H. Hietbrink, Falco Edwards, Michael J. R. Leenen, Luke P. H. Houwert, Roderick Marijn Frölke, Jan Paul M. affil: Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands sug: subj: Flail Chest Therapy Fracture Fixation Methods Rib Fractures Therapy Thoracic Injuries Complications Treatment Outcomes Human Prospective Studies Multicenter Studies Retrospective Design Critical Care Length of Stay Male Female Algorithms Adult Middle Age Aged Scales Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Over the years, a trend has evolved towards operative treatment of flail chest although evidence is limited. Furthermore, little is known about operative treatment for patients with multiple rib fractures without a flail chest. The aim of this study was to compare rib fixation based on a clinical treatment algorithm with nonoperative treatment for both patients with a flail chest or multiple rib fractures. Methods: All patients with ≥ 3 rib fractures admitted to one of the two contributing hospitals between January 2014 and January 2017 were retrospectively included in this multicenter cohort study. One hospital treated all patients nonoperatively and the other hospital treated patients with rib fixation according to a clinical treatment algorithm. Primary outcome measures were intensive care length of stay and hospital length of stay for patients with a flail chest and patients with multiple rib fractures, respectively. To control for potential confounding, propensity score matching was applied. Results: A total of 332 patients were treated according to protocol and available for analysis. The mean age was 56 (SD 17) years old and 257 (77%) patients were male. The overall mean Injury Severity Score was 23 (SD 11) and the average number of rib fractures was 8 (SD 4). There were 92 patients with a flail chest, 37 (40%) had rib fixation and 55 (60%) had non-operative treatment. There were 240 patients with multiple rib fractures, 28 (12%) had rib fixation and 212 (88%) had non-operative treatment. For both patient groups, after propensity score matching, rib fixation was not associated with intensive care unit length of stay (for flail chest patients) nor with hospital length of stay (for multiple rib fracture patients), nor with the secondary outcome measures. Conclusion: No advantage could be demonstrated for operative fixation of rib fractures. Future studies are needed before rib fixation is embedded or abandoned in clinical practice. pubtype: Academic Journal doctype: algorithm research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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