Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury

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 LeonSilvana 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*

*Corresponding author for this work

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Abstract

Purpose: Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale ≤ 12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients. Methods: A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. The primary outcome was mechanical ventilation-free days and secondary outcomes were in-hospital outcomes. In multivariable analysis, outcomes were assessed, stratified for rib fracture pattern. Results: In total, 449 patients were analyzed. In patients with a non-flail fracture pattern, 25 of 228 (11.0%) underwent SSRF and in patients with a flail chest, 86 of 221 (38.9%). In multivariable analysis, ventilator-free days were similar in both treatment groups. For patients with a non-flail fracture pattern, the odds of pneumonia were significantly lower after SSRF (odds ratio 0.29; 95% CI 0.11–0.77; p = 0.013). In patients with a flail chest, the ICU LOS was significantly shorter in the SSRF group (beta, − 2.96 days; 95% CI − 5.70 to − 0.23; p = 0.034). Conclusion: In patients with TBI and a non-flail fracture pattern, SSRF was associated with a reduced pneumonia risk. In patients with TBI and a flail chest, a shorter ICU LOS was observed in the SSRF group. In both groups, SSRF was safe and did not hamper neurological recovery.

Original languageEnglish
Pages (from-to)3327-3338
Number of pages12
JournalEuropean Journal of Trauma and Emergency Surgery
Volume48
Issue number4
DOIs
Publication statusPublished - Aug 2022

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