Original article
General thoracic
Risk Factors for 24-Hour Mortality After Traumatic Rib Fractures Owing to Motor Vehicle Accidents: A Nationwide Population-Based Study

https://doi.org/10.1016/j.athoracsur.2009.06.002Get rights and content

Background

Accurate identification of patients at high risk of death as a result of major chest trauma is essential within a trauma system. We used 3-year population-based data in Taiwan to evaluate risk factors associated with 24-hour mortality among adults with obvious rib fractures and needing hospitalization after traffic accidents.

Methods

Pooled data from Taiwan's National Health Insurance Research Database for the years 2002 through 2004 were used. A total of 18,856 patients hospitalized with rib fractures after traffic accidents were included. Multivariate logistic regression using generalized estimating equations was performed to explore the relationship between 24-hour mortality and patients' age, sex, and comorbid conditions, as well as hospital characteristics, adjusting for social factors and any clustering of the sampled patients by hospital.

Results

Of patients in the sample, 459 (2.4%) died within 24 hours of admission. Patients who had six or more rib fractures were three times more likely to die within 24 hours of admission compared with patients with only one rib fracture (odds ratio [OR], 3.16; p < 0.001). The adjusted odds of death within 24 hours were higher for patients who had hemopneumothorax (OR, 3.15; p < 0.001), extremity fractures (OR, 1.74; p < 0.001), pelvic fractures (OR, 2.92; p < 0.001), head injuries (OR, 4.29; p < 0.001), spleen injury (OR, 1.83; p < 0.05), hepatic injury (OR, 4.39; p < 0.001), heart injury (OR, 4.48; p < 0.001), and diaphragm injury (OR, 3.16; p < 0.05) compared with patients who had none of these injuries.

Conclusions

We concluded that more than six ribs fractured, heart injuries, hepatic injuries, head injuries, and advanced age are the most important determinants of 24-hour mortality after thoracic trauma from traffic accidents.

Section snippets

Database

This study uses pooled data for the years 2002, 2003, and 2004 obtained from the National Health Insurance Research Database published by Taiwan's National Health Research Institute. The National Health Insurance Research Database covers all medical benefit claims for approximately 98% of the entire Taiwan population. The National Health Insurance Research Database also includes a registry of contracted medical facilities, a registry of board-certified surgeons, and details of orders and

Results

Table 1 describes the distribution of the sampled patients by patient demographics and hospital characteristics. Of the total 18,856 patients hospitalized for rib fractures during the 3-year study period, 70.1% were male, and the mean age of the patients was 53.6 years (standard deviation, 15.6 years).

Among the study sample, 459 patients (2.4%) were dead within 24 hours after admission, contributing to 55% of all 30-day mortalities (n = 827). Table 1 also presents the bivariate analyses of

Comment

In the modern era, motor vehicles are widespread and the incidence of traffic continues to rise. Rib fractures have been reported as the most common disorder associated with chest trauma, and almost 70% of these patients were hospitalized [7, 8, 9]. Our study explored the risk factors associated with 24-hour mortality after blunt chest trauma with fractured ribs resulting from motor vehicle accidents. We found that a total of 827 patients (4.4%) with traumatic rib fractures died within 30 days

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