Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Volumn 23, Issue 1, 2015, Pages

  Unsworth, Annalise ^a,c   Curtis, Kate ^a,b,c   Asha, Edward ^a,c  

^a ST GEORGE HOSPITAL   (Australia)

^b UNIVERSITY OF SYDNEY   (Australia)

^c UNIVERSITY OF NEW SOUTH WALES   (Australia)

Author keywords

Management interventions; Patient and health outcomes; Rib fractures

Indexed keywords

COMPLICATION; HEALTH CARE DELIVERY; HUMAN; RIB FRACTURES; THORACIC INJURIES; WOUNDS, NONPENETRATING;

DELIVERY OF HEALTH CARE; HUMANS; RIB FRACTURES; THORACIC INJURIES; WOUNDS, NONPENETRATING;

EID: 84924234449     PISSN: None     EISSN: 17577241     Source Type: Journal    
DOI: 10.1186/s13049-015-0091-5     Document Type: Review

References (88)

1. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma-Injury Infec Crit Care. 2000;48(6):1040-6. discussion 1046-1047.
2. Lee RB, Bass SM, Morris Jr JA, MacKenzie EJ. Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma-Injury Infect Crit Care. 1990;30(6):689-94.
3. Yeh DD, Kutcher ME, Knudson MM, Tang JF. Epidural analgesia for blunt thoracic injury-which patients benefit most? Injury. 2012;43(10):1667-71.
4. Wardhan R. Assessment and management of rib fracture pain in geriatric population: an ode to old age. Curr Opin Anaesthesiol. 2013;26(5):626-31.
5. Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001;10(5):320-7.
6. Barnea Y, Kashtan H, Skornick Y, Werbin N. Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 2002;45(1):43-6.
7. Elmistekawy E, Hammad AA. Isolated rib fractures in geriatric patients. Annals of Thoracic Med. 2007;2(4):166-8.
8. Bayouth L, Safcsak K, Cheatham ML, Smith CP, Birrer KL, Promes JT. Early intravenous ibuprofen decreases narcotic requirement and length of stay after traumatic rib fracture. Am Surg. 2013;79(11):1207-12.
9. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994;331(24):1601-6.
10. Brathwaite C, Mure A, O'Malley K, Spence R, Ross S. Complications of anticoagulation for pulmonary embolism in low risk trauma patients. CHEST J. 1993;104(3):718-20.
11. Gage A, Rivara F, Wang J, Jurkovich GJ, Arbabi S. The effect of epidural placement in patients after blunt thoracic trauma. J Trauma Acute Care Surg. 2014;76(1):39-46.
12. Mohta M, Verma P, Saxena AK, Sethi AK, Tyagi A, Girotra G. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs-a pilot study. J Trauma-Injury Infect Crit Care. 2009;66(4):1096-101.
13. Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology. 2002;96(3):725-41.
14. Sackett D, Richardson W, Rosenberg W, Haynes R. Evidence-based medicine: how to practice and teach EBM. Edinburgh: Churchill Livingstone; 1997.
15. Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53.
16. Karmakar MK, Ho AM-H. Acute pain management of patients with multiple fractured ribs. J Trauma-Injury, Infect Crit Care. 2003;54(3):615-25.
17. Balkan ME, Oktar GL, Kayi-Cangir A, Ergul EG. Emergency thoracotomy for blunt thoracic trauma. Annals Thoracic Cardiovasc Surg. 2002;8(2):78-82.
18. Kalina M, Teeple E, Fulda G. Are there still selected applications for resuscitative thoracotomy in the emergency department after blunt trauma? Del Med J. 2009;81(5):195-8.
19. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9.
20. Polit-O'Hara D, Hungler BP. Essentials of nursing research: methods, appraisal, and utilization. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 1993.
21. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Current methods of the US preventive services task force: a review of the process. Am J Prev Med. 2001;20(3):21-35.
22. Doben AR, Eriksson EA, Denlinger CE, Leon SM, Couillard DJ, Fakhry SM, et al. Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation. J Crit Care. 2014;29(1):139-43.
23. Borman JB, Aharonson-Daniel L, Savitsky B, Peleg K. Unilateral flail chest is seldom a lethal injury. Emerg Med J. 2006;23(12):903-5.
24. Freedland M, Wilson RF, Bender JS, Levison MA. The management of flail chest injury: factors affecting outcome. J Trauma-Injury Infect Crit Care. 1990;30(12):1460-8.
25. Althausen PL, Shannon S, Watts C, Thomas K, Bain MA, Coll D, et al. Early surgical stabilization of flail chest with locked plate fixation. J Orthop Trauma. 2011;25(11):641-7.
26. Voggenreiter G, Neudeck F, Aufmkolk M, Obertacke U, Schmit-Neuerburg KP. Outcome of operative chest wall stabilization in flail chest with or without pulmonary contusion. [German]. Unfallchirurg. 1996;99(6):425-34.
27. Nirula R, Allen B, Layman R, Falimirski ME, Somberg LB. Rib fracture stabilization in patients sustaining blunt chest injury. Am Surg. 2006;72(4):307-9.
28. Tanaka HYT, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727-32. discussion 732.
29. Granetzny A, El-Aal MA, Emam E, Shalaby A, Boseila A. Surgical versus conservative treatment of flail chest. Eval Pulm Status Interact Cardiovas Thoracic Surg. 2005;4(6):583-7.
30. Marasco SF, Davies AR, Cooper J, Varma D, Bennett V, Nevill R, et al. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg. 2013;216(5):924-32.
31. Truitt MS, Murry J, Amos J, Lorenzo M, Mangram A, Dunn E, et al. Continuous intercostal nerve blockade for rib fractures: Ready for primetime? J Trauma - Injury Infect Crit Care. 2011;71(6):1548-52.
32. Mackersie RC, Karagianes TG, Hoyt DB, Davis JW. Prospective evaluation of epidural and intravenous administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures. J Trauma-Injury, Infect Crit Care. 1991;31(4):443-51.
33. Asha SE, Curtis KA, Taylor C, Kwok A. Patient-controlled analgesia compared with interval analgesic dosing for reducing complications in blunt thoracic trauma: a retrospective cohort study. Emerg Med J. 2013;30(12):1024-8.
34. Karmakar MK, Critchley LA, Ho AM-H, Gin T, Lee TW, Yim AP. Continuous thoracic paravertebral infusion of bupivacaine for pain management in patients with multiple fractured ribs. CHEST J. 2003;123(2):424-31.
35. Ingalls NK, Horton ZA, Bettendorf M, Frye I, Rodriguez C. Randomized, double-blind, placebo-controlled trial using lidocaine patch 5% in traumatic rib fractures. J Am Coll Surg. 2010;210(2):205-9.
36. Moon MR, Luchette FA, Gibson SW, Crews J, Sudarshan G, Hurst JM, et al. Prospective, randomized comparison of epidural versus parenteral opioid analgesia in thoracic trauma. Ann Surg. 1999;229(5):684.
37. Wisner DH. A stepwise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia. J Trauma-Injury Infect Crit Care. 1990;30(7):799-804. discussion 804-795.
38. Bulger EM, Edwards T, Klotz P, Jurkovich GJ. Epidural analgesia improves outcome after multiple rib fractures. Surgery. 2004;136(2):426-30.
39. Wu CL, Jani ND, Perkins FM, Barquist E. Thoracic epidural analgesia versus intravenous patient-controlled analgesia for the treatment of rib fracture pain after motor vehicle crash. J Trauma-Injury Infect Crit Care. 1999;47(3):564-7.
40. Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87(3):479-86.
41. Zink KA, Mayberry JC, Peck EG, Schreiber MA. Lidocaine patches reduce pain in trauma patients with rib fractures. Am Surg. 2011;77(4):438-42.
42. Shukla AN, Ghaffar ZBA, Auang AC, Rajah U, Tan L. Continuous paravertebral block for pain relief in unilateral multiple rib fracture: a case series. Acute Pain. 2008;10(1):39-44.
43. Sesperez J, Wilson S, Jalaludin B, Seger M, Sugrue M. Trauma case management and clinical pathways: prospective evaluation of their effect on selected patient outcomes in five key trauma conditions. J Trauma-Injury Infect Crit Care. 2001;50(4):643-9.
44. Wilson S, Bin J, Sesperez J, Seger M, Sugrue M. Clinical pathways-can they be used in trauma care. An Anal Patient Inj. 2001;32(7):525-32.
45. Menditto VG, Gabrielli B, Marcosignori M, Screpante F, Pupita G, Polonara S, et al. A management of blunt thoracic trauma in an emergency department observation unit: pre-post observational study. J Trauma Acute Care Surg. 2012;72(1):222-8.
46. Sahr SM, Webb ML, Renner CH, Sokol RK, Swegle JR. Implementation of a rib fracture triage protocol in elderly trauma patients. J Trauma Nurs. 2013;20(4):172-5.
47. Todd SR, McNally MM, Holcomb JB, Kozar RA, Kao LS, Gonzalez EA, et al. A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. Am J Surg. 2006;192(6):806-11.
48. Adrales G, Huynh T, Broering B, Sing RF, Miles W, Thomason MH, et al. A thoracostomy tube guideline improves management efficiency in trauma patients. J Trauma-Inj Infect Crit Care. 2002;52(2):210-4. discussion 214-216.
49. Bolliger CT, Van Eeden SF. Treatment of multiple rib fractures. Randomized controlled trial comparing ventilatory with nonventilatory management Chest. 1990;97(4):943-8.
50. Walz M, Mollenhoff G, Muhr G. CPAP-augmented spontaneous respiration in thoracic trauma. An alternative to intubation. Unfallchirurg. 1998;101(7):527-36.
51. Gunduz M, Unlugenc H, Ozalevli M, Inanoglu K, Akman H. A comparative study of continuous positive airway pressure (CPAP) and intermittent positive pressure ventilation (IPPV) in patients with flail chest. Emerg Med J. 2005;22(5):325-9.
52. Fabbrucci P, Nocentini L, Secci S, Manzoli D, Bruscino A, Fedi M, et al. Video-assisted thoracoscopy in the early diagnosis and management of post-traumatic pneumothorax and hemothorax. Surg Endosc. 2008;22(5):1227-31.
53. Smith JW, Franklin GA, Harbrecht BG, Richardson JD. Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons. J Trauma-Inj Infect Crit Care. 2011;71(1):102-5. discussion 105-107.
54. Quick G. A randomized clinical trial of rib belts for simple fractures. Am J Emerg Med. 1990;8(4):277-81.
55. Avery E, Benson D, Morch E. Critically crushed chests; a new method of treatment with continuous mechanical hyperventilation to produce alkalotic apnea and internal pneumatic stabilization. J Thorac Surg. 1956;32(3):291-311.
56. Chiumello D, Coppola S, Froio S, Gregoretti C, Consonni D. Noninvasive ventilation in chest trauma: systematic review and meta-analysis. Intensive Care Med. 2013;39(7):1171-80.
57. Shackford SR, Smith DE, Zarins CK, Rice CL, Virgilio RW. The management of flail chest: a comparison of ventilatory and nonventilatory treatment. Am J Surg. 1976;132(6):759-62.
58. Trinkle JK, Richardson JD, Franz JL, Grover FL, Arom KV, Holmstrom FM. Management of flail chest without mechanical ventilation. Ann Thorac Surg. 1975;19(4):355-63.
59. Pettiford BL, Luketich JD, Landreneau RJ. The management of flail chest. Thorac Surg Clin. 2007;17(1):25-33.
60. De Moya M, Bramos T, Agarwal S, Fikry K, Janjua S, King DR, et al. Pain as an indication for rib fixation: a bi-institutional pilot study. J Trauma - Inj, Infect Crit Care. 2011;71(6):1750-4.
61. Schwed AC, Sonnad SS, Holena DN, Pascual JL, Reilly PM, Sims CA. Take a deep breath!: managing rib fractures in elderly trauma patients. J Surg Res. 2013;179:2.
62. Barrett-Connor E, Nielson CM, Orwoll E, Bauer DC, Cauley JA. Epidemiology of rib fractures in older men: osteoporotic fractures in men (MrOS) prospective cohort study. BMJ. 2010;00:00 2010:340.
63. Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma - Inj Infect Crit Care. 2003;54(3):478-85.
64. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975-9.
65. Sharma OP, Oswanski MF, Jolly S, Lauer SK, Dressel R, Stombaugh HA. Perils of rib fractures. Am Surg. 2008;74(4):310-4.
66. Winters BA. older adults with traumatic rib fractures: an evidence based approach to their care. Int J Trauma Nurs. 2009;16(2):93-7.
67. Dutton RP, Mackenzie CF, Scalea TM. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma-Inj Infect Crit Care. 2002;52(6):1141-6.
68. Hunter B, Segrott J. Re-mapping client journeys and professional identities: a review of the literature on clinical pathways. Int J Nurs Stud. 2008;45(4):608-25.
69. Rotter T, Kugler J, Koch R, Gothe H, Twork S, van Oostrum JM, et al. A systematic review and meta-analysis of the effects of clinical pathways on length of stay, hospital costs and patient outcomes. BMC Health Serv Res. 2008;8(1):265.
70. Vanhaecht K, Panella M, Van Zelm R, Sermeus W. An overview on the history and concept of care pathways as complex interventions. Intl J Care Pathw. 2010;14(3):117-23.
71. Goldberger JJ, Buxton AE. Personalized medicine vs guideline-based medicine. Jama. 2013;309(24):2559-60.
72. Bansidhar BJ, Lagares-Garcia JA, Miller S. Clinical rib fractures: are follow-up chest X-rays a waste of resources? Am Surg. 2002;68(5):449-53.
73. Campbell H, Hotchkiss R, Bradshaw N, Porteous M. Integrated care pathways. BMJ: British Med J. 1998;316(7125):133.
74. Curtis K, Zou Y, Morris R, Black D. Trauma case management: improving patient outcomes. Injury. 2006;37(7):626-32.
75. Dutton RP, Cooper C, Jones A, Leone S, Kramer ME, Scalea TM. Daily multidisciplinary rounds shorten length of stay for trauma patients. J Trauma-Inj Infect Crit Care. 2003;55(5):913-9.
76. Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf. 2005;31(5):243-8.
77. Huber S, Biberthaler P, Delhey P, Trentzsch H, Winter H, van Griensven M, et al. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®). Scand J Trauma Resusc Emerg Med. 2014;22(1):52-2.
78. Geiger EV, Lustenberger T, Wutzler S, Lefering R, Lehnert M, Walcher F, et al. Predictors of pulmonary failure following severe trauma: a trauma registry-based analysis. Scand J Trauma Resusc Emerg Med. 2013;21(1):34.
79. Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):596-608.
80. Cohn MDLH, Rosborough RND, Fernandez MPAJ. Reducing costs and length of stay and improving efficiency and quality of care in cardiac surgery. Ann Thorac Surg. 1997;64(6):S58-60.
81. Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg. 2003;23(3):374-8.
82. Clini E, Ambrosino N. Early physiotherapy in the respiratory intensive care unit. Respir Med. 2005;99(9):1096-104.
83. Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995;110(6):1676-80.
84. Hakim SM, Latif FS, Anis SG. Comparison between lumbar and thoracic epidural morphine for severe isolated blunt chest wall trauma: a randomized open-label trial. J Anesth. 2012;26(6):836-44.
85. Topcu I, Ekici Z, Sakarya M. [Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit]. Ulusal Travma ve Acil Cerrahi Dergisi=Turkish J Trauma & Emerg Surg: TJTES. 2007;13(3):205-10.
86. Kieninger AN, Bair HA, Bendick PJ, Howells GA. Epidural versus intravenous pain control in elderly patients with rib fractures. Am J Surg. 2005;189(3):327-30.
87. Pierre EJ, Martin P, Frohock J, Varon AJ, Barquist E. Lumbar epidural morphine versus. Patient-controlled analgesia morphine in patients with multiple rib fractures. Anesthesiology. 2005;103(A289):A289.
88. Lohr KN. Rating the strength of scientific evidence: relevance for quality improvement programs. Int J Qual Health Care. 2004;16(1):9-18.