Operative Stabilization of Flail Chest Injuries Reduces Mortality to That of Stable Chest Wall Injuries

作者：Niloofar Dehghan, Jeffrey Mah, Emil H. Schemitsch, Aaron Nauth, Milena Vicente, Michael D. McKee · 发表于：Journal of Orthopaedic Trauma · 年份：2017 · DOI：10.1097/bot.0000000000000992 · 被引用次数：63 · 研究领域：Trauma Management and Diagnosis、Traumatic Ocular and Foreign Body Injuries、Spinal Fractures and Fixation Techniques

OBJECTIVE: To determine the prevalence, management and outcomes of patients with flail chest injuries, compared to patients without flail chest injuries (single rib fractures and multiple rib fractures without a flail segment). DESIGN: Retrospective cohort study. SETTING: Ontario, Canada. PARTICIPANTS: Ontario residents over the age of 16 years who had been admitted to hospital with a chest wall injury from 2004 to 2015 were identified using administrative health care databases. MAIN OUTCOME MEASUREMENTS: Outcomes included treatment modalities such as rate of surgical repair, days on mechanical ventilation, days in the intensive care unit, days in hospital, rate of chest tube placement; and rates of complication, including pneumonia, tracheostomy, readmission, and death. RESULTS: In total 117,204 patients with fractures of the chest wall were identified. Of the entire cohort, 1.5% of them had a flail chest injury, 41% had multiple rib fractures, and 58% had single rib fractures. Patients with flail chest injuries had significantly worse outcomes compared to patients with multiple rib fractures in all categories (P < 0.0001). Similarly, patients with multiple rib fractures had significantly worst outcomes compared with patients with single rib fractures (P < 0.0001). Only 4.5% of patients with flail chest injuries were treated surgically, however, the number increased from 1% before 2010 to 10% after 2010 (P < 0.0001). After adjustment for potential confounders, patients with ...