Article Text

Download PDFPDF
Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis
  1. Ceri Battle1,
  2. Kym Carter2,
  3. Luke Newey1,
  4. Jacopo Davide Giamello3,4,
  5. Remo Melchio5,
  6. Hayley Hutchings2
  1. 1Physiotherapy Department, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
  2. 2Swansea Trials Unit, Swansea University, Swansea, UK
  3. 3School of Emergency Medicine, Università degli Studi di Torino Dipartimento di Scienze Mediche, Torino, Italy
  4. 4Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
  5. 5Department of Internal Medicine, Santa Croce e Carle Hospital, Cuneo, Italy
  1. Correspondence to Dr Ceri Battle, Physiotherapy Dept, Morriston Hospital, Swansea, UK; ceri.battle{at}


Background Over the last 10 years, research has highlighted emerging potential risk factors for poor outcomes following blunt chest wall trauma. The aim was to update a previous systematic review and meta-analysis of the risk factors for mortality in blunt chest wall trauma patients.

Methods A systematic review of English and non-English articles using MEDLINE, Embase and Cochrane Library from January 2010 to March 2022 was completed. Broad search terms and inclusion criteria were used. All observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. Where sufficient data were available, ORs with 95% CIs were calculated using a Mantel-Haenszel method. Heterogeneity was assessed using the I2 statistic.

Results 73 studies were identified which were of variable quality (including 29 from original review). Identified risk factors for mortality following blunt chest wall trauma were: age 65 years or more (OR: 2.11; 95% CI 1.85 to 2.41), three or more rib fractures (OR: 1.96; 95% CI 1.69 to 2.26) and presence of pre-existing disease (OR: 2.86; 95% CI 1.34 to 6.09). Other new risk factors identified were: increasing Injury Severity Score, need for mechanical ventilation, extremes of body mass index and smoking status. Meta-analysis was not possible for these variables due to insufficient studies and high levels of heterogeneity.

Conclusions The results of this updated review suggest that despite a change in demographics of trauma patients and subsequent emerging evidence over the last 10 years, the main risk factors for mortality in patients sustaining blunt chest wall trauma remained largely unchanged. A number of new risk factors however have been reported that need consideration when updating current risk prediction models used in the ED.

PROSPERO registration number CRD42021242063. Date registered: 29 March 2021.

  • chest
  • trauma
  • risk management

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text


  • Handling editor Edward Carlton

  • Twitter @ceribattle

  • Contributors CB, LN, KC, JDG, RM and HH all designed the study. KC and CB completed the searches. CB and LN carried out the study selection, data extraction and quality assessment. CB, JDG, RM and KC completed the data analysis. CB wrote the first draft of the manuscript and LN, KC, JDG, RM and HH all contributed to the revision and final draft. CB acts as guarantor for this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.