TY - JOUR
T1 - Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury
AU - Prins, Jonne T.H.
AU - Van Lieshout, Esther M.M.
AU - Ali-Osman, Francis
AU - Bauman, Zachary M.
AU - Caragounis, Eva Corina
AU - Choi, Jeff
AU - Christie, D. Benjamin
AU - Cole, Peter A.
AU - DeVoe, William B.
AU - Doben, Andrew R.
AU - Eriksson, Evert A.
AU - Forrester, Joseph D.
AU - Fraser, Douglas R.
AU - Gontarz, Brendan
AU - Hardman, Claire
AU - Hyatt, Daniel G.
AU - Kaye, Adam J.
AU - Ko, Huan Jang
AU - Leasia, Kiara N.
AU - Leon, Stuart
AU - Marasco, Silvana F.
AU - McNickle, Allison G.
AU - Nowack, Timothy
AU - Ogunleye, Temi D.
AU - Priya, Prakash
AU - Richman, Aaron P.
AU - Schlanser, Victoria
AU - Semon, Gregory R.
AU - Su, Ying Hao
AU - Verhofstad, Michael H.J.
AU - Whitis, Julie
AU - Pieracci, Fredric M.
AU - Wijffels, Mathieu M.E.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/8
Y1 - 2022/8
N2 - 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.
AB - 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.
KW - Flail chest
KW - Rib fracture
KW - Surgical stabilization of rib fractures
KW - Thoracic trauma
KW - Traumatic brain injury
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U2 - 10.1007/s00068-022-01906-1
DO - 10.1007/s00068-022-01906-1
M3 - Article
C2 - 35192003
AN - SCOPUS:85124988792
SN - 1863-9933
VL - 48
SP - 3327
EP - 3338
JO - European Journal of Trauma and Emergency Surgery
JF - European Journal of Trauma and Emergency Surgery
IS - 4
ER -
