Increasing Numbers of Rib Fractures Do Not Worsen Outcome: An Analysis of the National Trauma Data Bank

Am Surg. 2013 Feb;79(2):140-50.

Abstract

Increasing age and number of rib fractures are thought to portend a worse outcome with blunt chest trauma, although this is not clearly substantiated in the literature. We hypothesized that these parameters have a significant and synergistic effect, worsening patient outcome. Using the National Trauma Data Bank, we evaluated patients from 2002 to 2006. Patients with a rib fracture International Classification of Diseases, 9th Revision code were included; those with sternal fractures were excluded. Data on demographics, injury, comorbidity, complications, intensive care unit duration, ventilator duration, length of stay, and death were collected. Significant univariate predictors were included in the multivariate logistic regression analysis to adjust for any potential confounders. We identified 35,467 patients who met the inclusion. The mean age was 45.5 years with a mean Injury Severity Score of 19.3. There were 2.1 per cent open rib fractures. Using univariate analysis, rib fracture number was significant. However, once multivariate analyses were applied, the number of rib fractures was not found to be an independent predictor of outcome. The number of rib fractures is not an independent predictor of outcome. Age and overall trauma burden are more powerful predictors of poor outcomes. Treatment focus should shift from the chest to the broader scope of injuries and comorbidities.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Critical Care / statistics & numerical data
  • Databases, Factual
  • Female
  • Hospital Mortality
  • Humans
  • Injury Severity Score
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Multiple Trauma* / complications
  • Multiple Trauma* / diagnosis
  • Multiple Trauma* / mortality
  • Multiple Trauma* / therapy
  • Multivariate Analysis
  • Outcome Assessment, Health Care
  • Prognosis
  • Proportional Hazards Models
  • ROC Curve
  • Rib Fractures* / complications
  • Rib Fractures* / diagnosis
  • Rib Fractures* / mortality
  • Rib Fractures* / therapy
  • United States
  • Wounds, Nonpenetrating* / complications
  • Wounds, Nonpenetrating* / diagnosis
  • Wounds, Nonpenetrating* / mortality
  • Wounds, Nonpenetrating* / therapy