The Southwestern Surgical CongressPredicting outcome of patients with chest wall injury
Section snippets
Methods
This study was performed at a busy, state-designated level 1 trauma center. After obtaining approval from the institutional review board, a simple scoring system to stratify risk for patients with rib fractures was developed on the basis of currently available literature (Table 1). The scoring system was specifically formulated to use clinical data available at the time of initial patient evaluation. The validity of the scoring system was tested by retrospectively applying the system to a large
Mortality
Patients with total scores ≤ 7 had a statistically significant lower mortality rate (24 of 579 [4.2%]) compared with patients with total scores > 7 (10 of 70 [14.3%]) (Fisher's 2-sided P = .0018).
ICU admission
Patients with a total scores ≤ 6 were less likely to be admitted to an ICU (29.7%) compared with patients with total scores ≥ 7 (56.7%) (P < .0001).
Mechanical ventilation
Patients with total scores < 7 were less likely to require intubation and mechanical ventilation (20.6%) compared with those with scores ≥ 7 (40.0%) (P <
Comments
Much of the respiratory insufficiency associated with chest wall injury is due to pain associated with rib fractures. Whether because of chest wall deformity or decreased respiratory effort in attempts to reduce pain with breathing, the loss of normal pulmonary function decreases gas exchange and the ability to clear secretions, increases atelectasis, and is associated with the development of pneumonia. Continued decline in respiratory effort and pulmonary function results in the need for
Conclusions
A scoring system can be used to predict which patients are more likely to require mechanical ventilation and require prolonged courses of care, as well as those with a higher mortality risk. Patients with total scores ≥ 7 are at greater risk for mortality, admission to an ICU, and mechanical ventilation. Patients with scores ≥ 5 are more likely to experience longer lengths of stay and mechanical ventilation. The use of this scoring system may help in the immediate identification of patients who
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