Fredric M Pieracci1, Suresh Agarwal2, Andrew Doben3, Adam Shiroff4, Larwence Lottenberg5, Sarah Ann Whitbeck6, Thomas W White6. 1. Denver Health Medical Center, Denver, CO, USA. Fredric.pieracci@dhha.org. 2. Duke University School of Medicine, Durham, NC, USA. 3. Baystate Medical Center, Springfield, MA, USA. 4. University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 5. St. Mary's Medical Center, West Palm Beach, FL, USA. 6. Intermountain Medical Center, Salt Lake City, UT, USA.
Abstract
PURPOSE: There are currently no evidence-based indications for surgical stabilization of rib fractures (SSRF) in patients without flail chest. The purpose of this survey was to identify patients for whom there is relative equipoise (operative vs. non-operative) in order to assist in designing a randomized clinical trial. METHODS: Members of the Chest Wall Injury Society were sent an online survey, in which 18 patient scenarios were presented. The baseline patient had ≥ three displaced, contiguous fractures and had no other contraindications for surgery. This default scenario was then varied based upon patient age, degree of traumatic brain injury (TBI), fracture series location, and number of abnormal pulmonary physiologic variables (oxygen requirement, respiratory rate, incentive spirometry ability, cough, and numeric pain score). RESULTS: Thirty respondents provided a total of 540 answers. Overall, the majority of responses were in favor of SSRF (n = 413, 84.1%). Furthermore, the vast majority of responses indicated that some degree of pulmonary compromise was necessary to recommend SSRF (n = 44, 90.4%), with ≥ two abnormal parameters being the most common threshold (n = 156, 31.8%). Decision to recommend SSRF varied significantly by number of abnormal clinical variables, age, and degree of TBI, but not by fracture series location. Patients aged 85 years old and those with moderate TBI were the least likely to be recommended for SSRF, regardless of abnormal pulmonary physiologic variables. The most appropriate cutoff for equipoise appeared to be a patient aged 21-79 years old, with no or mild TBI, ≥ two abnormal pulmonary parameters, and regardless of fracture location (44.8% consensus for SSRF). CONCLUSIONS: SSRF was recommended for most patients with non-flail, displaced rib fractures. However, this recommendation was contingent upon patient age, degree of TBI, and pulmonary clinical status. Results of this survey may be used to inform inclusion criteria for a future randomized, clinical trial.
PURPOSE: There are currently no evidence-based indications for surgical stabilization of rib fractures (SSRF) in patients without flail chest. The purpose of this survey was to identify patients for whom there is relative equipoise (operative vs. non-operative) in order to assist in designing a randomized clinical trial. METHODS: Members of the Chest Wall Injury Society were sent an online survey, in which 18 patient scenarios were presented. The baseline patient had ≥ three displaced, contiguous fractures and had no other contraindications for surgery. This default scenario was then varied based upon patient age, degree of traumatic brain injury (TBI), fracture series location, and number of abnormal pulmonary physiologic variables (oxygen requirement, respiratory rate, incentive spirometry ability, cough, and numeric pain score). RESULTS: Thirty respondents provided a total of 540 answers. Overall, the majority of responses were in favor of SSRF (n = 413, 84.1%). Furthermore, the vast majority of responses indicated that some degree of pulmonary compromise was necessary to recommend SSRF (n = 44, 90.4%), with ≥ two abnormal parameters being the most common threshold (n = 156, 31.8%). Decision to recommend SSRF varied significantly by number of abnormal clinical variables, age, and degree of TBI, but not by fracture series location. Patients aged 85 years old and those with moderate TBI were the least likely to be recommended for SSRF, regardless of abnormal pulmonary physiologic variables. The most appropriate cutoff for equipoise appeared to be a patient aged 21-79 years old, with no or mild TBI, ≥ two abnormal pulmonary parameters, and regardless of fracture location (44.8% consensus for SSRF). CONCLUSIONS: SSRF was recommended for most patients with non-flail, displaced rib fractures. However, this recommendation was contingent upon patient age, degree of TBI, and pulmonary clinical status. Results of this survey may be used to inform inclusion criteria for a future randomized, clinical trial.
Entities:
Keywords:
Rib fractures; Surgical stabilization of rib fractures; Survey
Authors: Niloofar Dehghan; Charles de Mestral; Michael D McKee; Emil H Schemitsch; Avery Nathens Journal: J Trauma Acute Care Surg Date: 2014-02 Impact factor: 3.313
Authors: Fredric M Pieracci; Maria Rodil; Robert T Stovall; Jeffrey L Johnson; Walter L Biffl; Cyril Mauffrey; Ernest E Moore; Gregory J Jurkovich Journal: J Trauma Acute Care Surg Date: 2015-04 Impact factor: 3.313
Authors: Fredric M Pieracci; Sarah Majercik; Francis Ali-Osman; Darwin Ang; Andrew Doben; John G Edwards; Bruce French; Mario Gasparri; Silvana Marasco; Christian Minshall; Babak Sarani; William Tisol; Don H VanBoerum; Thomas W White Journal: Injury Date: 2016-11-27 Impact factor: 2.586
Authors: George Kasotakis; Erik A Hasenboehler; Erik W Streib; Nimitt Patel; Mayur B Patel; Louis Alarcon; Patrick L Bosarge; Joseph Love; Elliott R Haut; John J Como Journal: J Trauma Acute Care Surg Date: 2017-03 Impact factor: 3.313
Authors: Andrew R Doben; Evert A Eriksson; Chadrick E Denlinger; Stuart M Leon; Deborah J Couillard; Samir M Fakhry; Christian T Minshall Journal: J Crit Care Date: 2013-09-24 Impact factor: 3.425
Authors: Jonne T H Prins; Esther M M Van Lieshout; Francis Ali-Osman; Zachary M Bauman; Eva-Corina Caragounis; Jeff Choi; D Benjamin Christie; Peter A Cole; William B DeVoe; Andrew R Doben; Evert A Eriksson; Joseph D Forrester; Douglas R Fraser; Brendan Gontarz; Claire Hardman; Daniel G Hyatt; Adam J Kaye; Huan-Jang Ko; Kiara N Leasia; Stuart Leon; Silvana F Marasco; Allison G McNickle; Timothy Nowack; Temi D Ogunleye; Prakash Priya; Aaron P Richman; Victoria Schlanser; Gregory R Semon; Ying-Hao Su; Michael H J Verhofstad; Julie Whitis; Fredric M Pieracci; Mathieu M E Wijffels Journal: Eur J Trauma Emerg Surg Date: 2022-02-22 Impact factor: 2.374
Authors: Mustafa Sinan Bakir; Andreas Langenbach; Melina Pinther; Rolf Lefering; Sebastian Krinner; Marco Grosso; Axel Ekkernkamp; Stefan Schulz-Drost Journal: Eur J Trauma Emerg Surg Date: 2021-11-05 Impact factor: 2.374
Authors: Mathieu M E Wijffels; Jonne T H Prins; Suzanne Polinder; Taco J Blokhuis; Erik R De Loos; Roeland H Den Boer; Elvira R Flikweert; Albert F Pull Ter Gunne; Akkie N Ringburg; W Richard Spanjersberg; Pieter J Van Huijstee; Gust Van Montfort; Jefrey Vermeulen; Dagmar I Vos; Michael H J Verhofstad; Esther M M Van Lieshout Journal: World J Emerg Surg Date: 2019-07-30 Impact factor: 5.469
Authors: Arthur A R Sweet; Reinier B Beks; Frank F A IJpma; Mirjam B de Jong; Frank J P Beeres; Luke P H Leenen; Roderick M Houwert; Mark C P M van Baal Journal: Eur J Trauma Emerg Surg Date: 2021-06-01 Impact factor: 2.374