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  • Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database

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Original article
Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database
  1. Ian Ayenga Sammy1,2⇑,
  2. Hridesh Chatha3,
  3. Fiona Lecky4,
  4. Omar Bouamra4,
  5. Marisol Fragoso-Iñiguez4,
  6. Abdo Sattout3,
  7. Michael Hickey3,
  8. John E Edwards1
  1. 1 School of Health and Related Research, The University of Sheffield, Sheffield, UK
  2. 2 Department of Clinical Surgical Sciences, The University of the West Indies, Champs Fleurs, Trinidad and Tobago
  3. 3 Emergency Department, Aintree University Hospitals, Liverpool, UK
  4. 4 The Trauma Audit and Research Network, University of Manchester, Salford, UK
  1. Correspondence to Dr Ian Ayenga Sammy, School of Health and Related Research, The University of Sheffield, 30 Regent Street, Sheffield, South Yorkshire S1 4DA, UK; ian.sammy{at}sheffield.ac.uk

Abstract

Background First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted.

Methods Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality.

Results There were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19).

Conclusion First rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries.

  • emergency department
  • fractures and dislocations
  • imaging
  • CT/MRI
  • Trauma
  • chest
  • major trauma management

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/emermed-2016-206077

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    Footnotes

    • Contributors HC conceived the initial research question, designed the study, collected, analysed and interpreted the data and produced the final manuscript. IAS designed the study, analysed and interpreted the data and produced the final manuscript. FL advised on the study design, supervised the study, contributed to data interpretation and supervised production of the final manuscript. OB and MF-I collated and analysed the data and contributed to data interpretation and production of the final manuscript. MH and AS contributed to the development of the original research question and study design and advised on data interpretation and production of the final manuscript. JE advised on the study design, data interpretation and production of the final manuscript. HC and IAS are responsible for the overall content as guarantors.

    • Funding TARN is funded by subscription from its member hospitals in England, Wales, Ireland, Denmark and Switzerland.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.