Functional Impact of a Minor Thoracic Injury: An Investigation of Age, Delayed Hemothorax, and Rib Fracture Effects

Ann Surg. 2015 Dec;262(6):1115-22. doi: 10.1097/SLA.0000000000000952.


Objective: To investigate whether minor thoracic injuries (MTIs) relate to subsequent functional limitations.

Background: Approximately 75% of patients with an MTI are discharged after an emergency department (ED) visit, whereas significant functional limitations can occur in the weeks that follow.

Methods: A 19 months' prospective cohort study with a 90-day follow-up was conducted at 4 university-affiliated EDs. Patients 16 years and older with an MTI were assessed at initial ED visit, 7, 14, 30, and 90 days after injury. Functional outcome was measured using the SF-12 scale. General linear model were used to assess outcome.

Results: A total of 482 patients were included, of whom 127 (26.3%) were 65 or older. Overall, 147 patients (30.5%) presented with at least 1 rib fracture and 59 subjects (12.2%) with delayed hemothorax. At 90 days, 22.8% of patients still had severe or moderate disabilities on global physical health score. Patients with solely delayed hemothorax and no rib fracture had the lowest global physical health score (46.4 vs 61.1, P < 0.01, effect size = -2.60) than patients with simple MTI. Generally, functional limitations also increase with increments of number of rib fracture detected on radiograph. Outcomes were not different among patients 65 years or older when compared to their younger counterparts.

Conclusions: In this prospective study of MTIs, severe to moderate disabilities were present in nearly 1 patient out of 5 at 90 days. The presence of delayed hemothorax and the number of rib fracture were associated with increased functional limitations after a MTI.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Disability Evaluation*
  • Emergency Service, Hospital
  • Female
  • Follow-Up Studies
  • Health Surveys
  • Hemothorax / etiology
  • Hemothorax / physiopathology
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Patient Discharge
  • Prospective Studies
  • Recovery of Function
  • Rib Fractures / complications
  • Rib Fractures / physiopathology
  • Thoracic Injuries / complications
  • Thoracic Injuries / physiopathology*
  • Trauma Severity Indices
  • Young Adult