Impact of traumatic rib fractures on pulmonary morbidity and mortality: A multicenter prospective study

Objective: Rib fractures (RF) and associated injuries are a frequent traumatic injury associated with a relatively high morbidity and mortality. Methods: Between 2011 and 2013,287 patients with blunt thoracic trauma and RF are prospectively analyzed.Number of RF,flail chest,pulmonary morbidity,concomitant injuries,and mortality are recorded. Results: The mechanism of trauma was road traffic accidents in 119 patients,falls in 114,animal-related-trauma in 26,industrial accidents in 16,and assault in 12.Pulmonary complications such as pulmonary contusion (29.3%),hemo-pneumothorax (16%),subcutaneous emphysema (15%),pneumothorax (12.5%),hemothorax (11.5%),and flail chest (5.6%) were observed.Number of RF was significantly related with the presence of pulmonary complications (p<0.05).Thoracotomy was required in 5 patients (1.7%).Number of RF and hemo-pneumothorax was the significant risk factors for necessity of a thoracotomy (p=0.002 and p=0.03).Mortality was calculated as 2.4% (n=7).On univariate analysis,in patients with more than five RF (p=0.0007),flail chest (p=0.05),thoracotomy (p=0.0001),hemo-pneumothorax (p=0.01) or concomitant injuries (p=0.001) were found to be significant risk factors for mortality.By multivariate analysis,only three factors significantly influenced mortality:number of RF (p=0.03),concomitant injuries (p=0.02) or need a thoracotomy p(p=0.01). Conclusion: The risk of pulmonary complications was associated with number of RF increase.Mortality is encountered more frequently in patients with five or more RF,high NISS/ISS,or indication for a thoracotomy.In such cases,the suitable approach should be considered.