Helen Ma Ingoe1, William Eardley2, Catriona McDaid3, Amar Rangan4, Tom Lawrence5, Catherine Hewitt6. 1. York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD; The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW. Electronic address: helen.ingoe@york.ac.uk. 2. York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD; The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW. Electronic address: william.eardley@york.ac.uk. 3. York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD. Electronic address: catriona.mcdaid@york.ac.uk. 4. York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD; The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW; NDORMS, University of Oxford, research supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). Electronic address: amar.rangan@york.ac.uk. 5. Trauma and Audit Research Network, Manchester Medical Academic Health Sciences Centre, University of Manchester, The Mayo Building, Salford Royal Hospital, Salford M6 8HD. Electronic address: Tom.Lawrence@manchester.ac.uk. 6. York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD. Electronic address: catherine.hewitt@york.ac.uk.
Abstract
INTRODUCTION: Chest wall trauma is commonly seen in patients admitted with both high and low-energy transfer injury. Whilst often associated with other injuries, it is also seen in isolation following simple falls in the older patient. Fixation of the chest wall grows in popularity as part of optimising patient care, particularly in terms of critical care stay. There is currently no description of the epidemiology of these injuries at a national level; nor has there been identification of factors that predict which of these patients undergoes surgery. METHODS: The United Kingdom Trauma Audit & Research Network (TARN) database was analysed for the period April 2016 to 30th May 2017 for all adult patients presenting with a rib or sternal fracture. Characteristics of the population were described and a binary logistic regression model constructed to explore the influences of several explanatory variables on whether fixation was performed. RESULTS: Of 16,638 patients with chest wall trauma, 402 underwent fixation. Most chest wall injury patients were admitted under three specialties (orthopaedics (19.1%), emergency medicine (16.6%) and general surgery (17.7%)). The odds of fixation in unilateral flail chest was 107.51 (p <0.0001), in bilateral flail or combined complexsternal fracture 47.63 (p = 0.007) and in 3 or more non-flail ribs 15.62 (p<0.0001) when compared to less than three non-flail rib fractures. The odds of fixation was higher in an MTC (p<0.0001) compared to a non-specialist hospital. The odds of fixation was higher in older patients (1.02, p<0.0001) and the more severely injured (1.02, p<0.0001). CONCLUSION: There is considerable variation nationally in the management of chest wall trauma. Injury type, patient age and care setting contribute to decision making in fracture fixation. This unique national dataset characterises for the first time the nature of contemporary chest wall trauma management and should help inform the design of future research on this topic.
INTRODUCTION:Chest wall trauma is commonly seen in patients admitted with both high and low-energy transfer injury. Whilst often associated with other injuries, it is also seen in isolation following simple falls in the older patient. Fixation of the chest wall grows in popularity as part of optimising patient care, particularly in terms of critical care stay. There is currently no description of the epidemiology of these injuries at a national level; nor has there been identification of factors that predict which of these patients undergoes surgery. METHODS: The United Kingdom Trauma Audit & Research Network (TARN) database was analysed for the period April 2016 to 30th May 2017 for all adult patients presenting with a rib or sternal fracture. Characteristics of the population were described and a binary logistic regression model constructed to explore the influences of several explanatory variables on whether fixation was performed. RESULTS: Of 16,638 patients with chest wall trauma, 402 underwent fixation. Most chest wall injurypatients were admitted under three specialties (orthopaedics (19.1%), emergency medicine (16.6%) and general surgery (17.7%)). The odds of fixation in unilateral flail chest was 107.51 (p <0.0001), in bilateral flail or combined complexsternal fracture 47.63 (p = 0.007) and in 3 or more non-flail ribs 15.62 (p<0.0001) when compared to less than three non-flail rib fractures. The odds of fixation was higher in an MTC (p<0.0001) compared to a non-specialist hospital. The odds of fixation was higher in older patients (1.02, p<0.0001) and the more severely injured (1.02, p<0.0001). CONCLUSION: There is considerable variation nationally in the management of chest wall trauma. Injury type, patient age and care setting contribute to decision making in fracture fixation. This unique national dataset characterises for the first time the nature of contemporary chest wall trauma management and should help inform the design of future research on this topic.
Authors: Jonne T H Prins; Mathieu M E Wijffels; Sophie M Wooldrik; Martien J M Panneman; Michael H J Verhofstad; Esther M M Van Lieshout Journal: Eur J Trauma Emerg Surg Date: 2021-04-12 Impact factor: 2.374