Jeff Choi1, Aydin Kaghazchi2, Katherine L Dickerson3, Lakshika Tennakoon4, David A Spain4, Joseph D Forrester4. 1. Division of General Surgery, Department of Surgery, Stanford University, USA; Department of Epidemiology and Population Health, Stanford University, USA; Surgeons Writing About Trauma, Stanford University, USA. Electronic address: jc2226@stanford.edu. 2. Department of Epidemiology and Population Health, Stanford University, USA; Surgeons Writing About Trauma, Stanford University, USA. 3. Surgeons Writing About Trauma, Stanford University, USA; Department of Emergency Medicine, Massachusetts General Hospital, Harvard University, USA. 4. Division of General Surgery, Department of Surgery, Stanford University, USA; Surgeons Writing About Trauma, Stanford University, USA.
Abstract
BACKGROUND: We aimed to elucidate management patterns and outcomes of high-risk patients with rib fractures (elderly or flail chest) across non-trauma and trauma centers. We hypothesized highest-capacity (level I) centers would have best outcomes for high-risk patients. METHODS: We queried the 2016 National Emergency Department Sample to identify adults presenting with rib fractures. Multivariable regression assessed ED and inpatient events across non-trauma and level III/II/I trauma centers. RESULTS: Among 504,085 rib fracture encounters, 46% presented to non-trauma centers. Elderly patients with multiple rib fractures had stepwise increase in inpatient admission odds and stepwise decrease in pneumonia odds at higher-capacity trauma centers compared to non-trauma centers. Among patients with flail chest, odds of undergoing surgical stabilization (SSRF) increased at trauma centers. Undergoing SSRF was associated with reduced mortality but remained underutilized. CONCLUSION: Half of patients with rib fractures present to non-trauma centers. Nationwide care-optimization for high-risk patients requires further effort.
BACKGROUND: We aimed to elucidate management patterns and outcomes of high-risk patients with rib fractures (elderly or flail chest) across non-trauma and trauma centers. We hypothesized highest-capacity (level I) centers would have best outcomes for high-risk patients. METHODS: We queried the 2016 National Emergency Department Sample to identify adults presenting with rib fractures. Multivariable regression assessed ED and inpatient events across non-trauma and level III/II/I trauma centers. RESULTS: Among 504,085 rib fracture encounters, 46% presented to non-trauma centers. Elderly patients with multiple rib fractures had stepwise increase in inpatient admission odds and stepwise decrease in pneumonia odds at higher-capacity trauma centers compared to non-trauma centers. Among patients with flail chest, odds of undergoing surgical stabilization (SSRF) increased at trauma centers. Undergoing SSRF was associated with reduced mortality but remained underutilized. CONCLUSION: Half of patients with rib fractures present to non-trauma centers. Nationwide care-optimization for high-risk patients requires further effort.
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