Table 3.
Patient, injury, and treatment characteristics and in-hospital outcomes in patients with a flail chest and moderate to severe traumatic brain injury who underwent surgical stabilization of rib fractures (SSRF) or nonoperative management
| All (n = 221) | SSRF (n = 86) | Nonoperative (n = 135) | p value | ||||
|---|---|---|---|---|---|---|---|
| Na | Na | Na | |||||
| Patient characteristics | |||||||
| Age (years) | 221 | 51 (40–62) | 86 | 49 (38–60) | 135 | 51 (42–62) | 0.508 |
| BMI (kg/m2) | 189 | 27.1 (23.9–31.3) | 78 | 27.8 (24.6–32.6) | 120 | 26.3 (23.5–30.0) | 0.057 |
| Sex (male) | 220 | 168 (76.4%) | 85 | 63 (74%) | 135 | 105 (77.8%) | 0.625 |
| Smoking | 163 | 59 (36.2%) | 101 | 28 (45%) | 62 | 31 (30.7%) | 0.067 |
| COPD | 221 | 16 (7.2%) | 86 | 11 (13%) | 135 | 5 (3.7%) | 0.016 |
| Diabetes mellitus | 221 | 23 (10.4%) | 86 | 11 (13%) | 135 | 12 (8.9%) | 0.373 |
| Injury characteristics | |||||||
| Fractured ribs (N) | 221 | 9 (8–12) | 86 | 9 (8–12) | 135 | 9 (7–12) | 0.855 |
| Bilateral rib fractures | 221 | 100 (45.2%) | 86 | 35 (41%) | 135 | 65 (48.1%) | 0.332 |
| Fracture in every rib region | 207 | 104 (50.2%) | 80 | 43 (54%) | 127 | 61 (48.0%) | 0.476 |
| ≥ 100% displacement of ≥ 3 ribs | 214 | 138 (64.5%) | 85 | 60 (71%) | 129 | 78 (60.5%) | 0.146 |
| Pneumothorax | 221 | 186 (84.2%) | 86 | 74 (86%) | 135 | 112 (83.0%) | 0.577 |
| Hemothorax | 220 | 140 (63.6%) | 85 | 54 (64%) | 135 | 86 (63.7%) | 1.000 |
| Pulmonary contusion | 219 | 165 (75.3%) | 86 | 64 (74%) | 133 | 101 (75.9%) | 0.873 |
| ISS | 221 | 34 (29–44) | 86 | 34 (29–43) | 135 | 36 (29–45) | 0.235 |
| Epidural hematoma | 221 | 15 (6.8%) | 86 | 3 (3%) | 135 | 12 (8.9%) | 0.171 |
| Subdural hematoma | 221 | 110 (49.8%) | 86 | 32 (37%) | 135 | 78 (57.8%) | 0.004 |
| Subarachnoid hemorrhage | 221 | 141 (63.8%) | 86 | 45 (52%) | 135 | 96 (71.1%) | 0.006 |
| Diffuse axonal injury | 221 | 43 (19.5%) | 86 | 16 (19%) | 135 | 27 (20.0%) | 0.863 |
| Intra-parenchymal hemorrhage | 221 | 55 (24.9%) | 86 | 22 (26%) | 135 | 33 (24.4%) | 0.874 |
| Intraventricular hemorrhage | 221 | 24 (10.9%) | 86 | 4 (5%) | 135 | 20 (14.8%) | 0.025 |
| Brain contusion | 221 | 50 (22.6%) | 86 | 22 (26%) | 135 | 28 (20.7%) | 0.414 |
| Intracranial hypertension | 221 | 48 (22.1%) | 86 | 10 (12%) | 135 | 38 (29.0%) | 0.003 |
| Severe TBI (GCS ≤ 8) | 221 | 178 (80.5%) | 86 | 62 (72%) | 135 | 116 (85.9%) | 0.015 |
| Treatment characteristics | |||||||
| Chest tube required | 221 | 180 (81.4%) | 86 | 77 (90%) | 135 | 103 (76.3%) | 0.014 |
| ICP reducing therapy required | 221 | 81 (36.7%) | 86 | 22 (26%) | 135 | 59 (43.7%) | 0.007 |
| Tracheostomy required | 221 | 81 (36.7%) | 86 | 25 (29%) | 135 | 56 (41.5%) | 0.065 |
| Additional surgeries required | |||||||
| Emergency thoracotomy | 221 | 12 (5.4%) | 86 | 7 (8%) | 135 | 5 (3.7%) | 0.223 |
| Emergency laparotomy | 221 | 29 (13.1%) | 86 | 9 (11%) | 135 | 20 (14.8%) | 0.417 |
| Pelvic surgery | 221 | 22 (10.0%) | 86 | 10 (12%) | 135 | 12 (8.9%) | 0.501 |
| Long bone surgery | 221 | 58 (26.2%) | 86 | 29 (34%) | 135 | 29 (21.5%) | 0.059 |
| Spine surgery | 221 | 17 (7.7%) | 86 | 4 (5%) | 135 | 13 (9.6%) | 0.205 |
| Outcome characteristics | |||||||
| Mechanical ventilation (days) | 221 | 10 (5–18) | 86 | 9 (5–14) | 135 | 11 (5–21) | 0.040 |
| Ventilator-free days (days) | 221 | 11 (4–21) | 86 | 13 (8–20) | 135 | 9 (1–21) | 0.034 |
| Motor GCS score recovery to 6 | 206 | 161 (78.2%) | 80 | 73 (91%) | 126 | 88 (69.8%) | < 0.001 |
| Time to motor GCS 6 (days) | 144 | 4 (2–11) | 69 | 4 (1–9) | 75 | 5 (2–14) | 0.075 |
| Pneumonia | 221 | 98 (44.3%) | 86 | 32 (37%) | 135 | 66 (48.9%) | 0.097 |
| Pleural empyema | 221 | 2 (0.9%) | 86 | 1 (1%) | 135 | 1 (0.7%) | 1.000 |
| ICU LOS | 221 | 14 (7–21) | 86 | 12 (7–17) | 135 | 15 (7–23) | 0.066 |
| HLOS | 221 | 22 (14–34) | 86 | 22 (16–33) | 135 | 23 (11–35) | 0.914 |
| 30-day mortality | 221 | 33 (14.9%) | 86 | 7 (8%) | 135 | 26 (19.3%) | 0.032 |
| In-hospital mortality | 221 | 34 (15.4%) | 86 | 7 (8%) | 135 | 27 (20.0%) | 0.021 |
| Mortality cause | |||||||
| Traumatic brain injury | 28 | 13 (46%) | 7 | 2 (29%) | 21 | 11 (52%) | 0.191 |
| Pulmonary origin | 28 | 6 (21%) | 7 | 1 (14%) | 21 | 5 (24%) | |
| Septic shock | 28 | 3 (11%) | 7 | 2 (29%) | 21 | 1 (5%) | |
| Hemorrhagic shock | 28 | 1 (4%) | 7 | 1 (14%) | 21 | 0 (0%) | |
| Cardiac origin | 28 | 3 (11%) | 7 | 1 (14%) | 21 | 2 (10%) | |
| Withdrawal of care | 28 | 1 (4%) | 7 | 0 (0%) | 21 | 2 (10%) | |
Data are shown as median (P25–P75) or as N (%)
BMI Body Mass Index, COPD Chronic Obstructive Pulmonary Disease, HLOS hospital length of stay, GCS Glasgow Coma Scale, ICP intracranial pressure, ICU LOS intensive care unit length of stay, ISS injury severity score, SSRF surgical stabilization of rib fractures, TBI traumatic brain injury
Bold and underlined p values are considered statistically significant
aProvides the exact number of patients for whom data were available