Closer to home: Managing more than three rib fractures at level IV trauma centers.

IF 2.9 2区 医学 Q2 CRITICAL CARE MEDICINE
Adam Lizak, Anthony Allsbrook, Rebecca Wilde-Onia, Lisa Robins, Rebecca Boyer, James Cipolla, Peter Thomas, Roberto Castillo, Maxwell A Braverman
{"title":"Closer to home: Managing more than three rib fractures at level IV trauma centers.","authors":"Adam Lizak, Anthony Allsbrook, Rebecca Wilde-Onia, Lisa Robins, Rebecca Boyer, James Cipolla, Peter Thomas, Roberto Castillo, Maxwell A Braverman","doi":"10.1097/TA.0000000000004575","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Rib fractures remain a significant source of trauma admissions. In 2020, the Pennsylvania Trauma System Foundation standards changed to allow patients with more than three rib fractures to be admitted to level IV centers. The primary aim of this study was to evaluate outcomes of patients with more than three uncomplicated rib fractures admitted to level IV trauma centers.</p><p><strong>Methods: </strong>Our network database was queried for patients with isolated uncomplicated rib fractures between 2018 and 2022. Patients were stratified based on evaluation before or after the change in standards. Patients evaluated at level IV centers were compared for demographics, injury characteristics, transfer rate, and outcomes. Finally, 1:1 propensity score matching was used to create a matched group of patients with more than three rib fractures to assess outcomes based on admission to level IV versus level I/II centers.</p><p><strong>Results: </strong>A total of 1,070 patients with isolated rib fractures were admitted over the study period. Level IV centers evaluated 360 patients with 132 (36.6%) and 228 (63.3%) in the pre- and poststandard change periods. There was a significant reduction in transfers for isolated rib fractures (56% vs. 21% p < 0.01). Compared with patients with three or less rib fractures, those with more than three fractures had similar hospital length of stay (median [interquartile range (IQR)], 3 [2-5] vs. 2 [1-4]; p = 0.29) and mortality (0% vs. 2.3%, p = 0.22). After propensity match, there was no difference in age (median [IQR], 71 [60-81] vs. 73 [65-85]; p = 0.24), injury characteristics, hospital length of stay (median [IQR], 2.5 [2-5] vs. 2 [1-4]; p = 0.37), and mortality (1.7% vs. 0%, p = 0.30).</p><p><strong>Conclusion: </strong>Change in state admission standards allowed for a reduction in transfer of patients with more than three isolated rib fractures. In a group of matched patients with more than three rib fractures, level IV centers had similar outcomes to level I or II centers.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"875-879"},"PeriodicalIF":2.9000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Trauma and Acute Care Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TA.0000000000004575","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/25 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: Rib fractures remain a significant source of trauma admissions. In 2020, the Pennsylvania Trauma System Foundation standards changed to allow patients with more than three rib fractures to be admitted to level IV centers. The primary aim of this study was to evaluate outcomes of patients with more than three uncomplicated rib fractures admitted to level IV trauma centers.

Methods: Our network database was queried for patients with isolated uncomplicated rib fractures between 2018 and 2022. Patients were stratified based on evaluation before or after the change in standards. Patients evaluated at level IV centers were compared for demographics, injury characteristics, transfer rate, and outcomes. Finally, 1:1 propensity score matching was used to create a matched group of patients with more than three rib fractures to assess outcomes based on admission to level IV versus level I/II centers.

Results: A total of 1,070 patients with isolated rib fractures were admitted over the study period. Level IV centers evaluated 360 patients with 132 (36.6%) and 228 (63.3%) in the pre- and poststandard change periods. There was a significant reduction in transfers for isolated rib fractures (56% vs. 21% p < 0.01). Compared with patients with three or less rib fractures, those with more than three fractures had similar hospital length of stay (median [interquartile range (IQR)], 3 [2-5] vs. 2 [1-4]; p = 0.29) and mortality (0% vs. 2.3%, p = 0.22). After propensity match, there was no difference in age (median [IQR], 71 [60-81] vs. 73 [65-85]; p = 0.24), injury characteristics, hospital length of stay (median [IQR], 2.5 [2-5] vs. 2 [1-4]; p = 0.37), and mortality (1.7% vs. 0%, p = 0.30).

Conclusion: Change in state admission standards allowed for a reduction in transfer of patients with more than three isolated rib fractures. In a group of matched patients with more than three rib fractures, level IV centers had similar outcomes to level I or II centers.

Level of evidence: Prognostic and Epidemiological; Level IV.

离家更近:在四级创伤中心处理超过三处肋骨骨折。
简介:肋骨骨折仍然是创伤入院的重要来源。2020年,宾夕法尼亚创伤系统基金会改变了标准,允许三根以上肋骨骨折的患者入住四级中心。本研究的主要目的是评估在IV级创伤中心接受三次以上无并发症肋骨骨折的患者的预后。方法:我们的网络数据库查询2018年至2022年期间孤立的非复杂性肋骨骨折患者。根据标准改变前后的评价对患者进行分层。在IV级中心评估的患者进行人口统计学、损伤特征、转移率和结果的比较。最后,采用1:1的倾向评分匹配来创建一组超过三根肋骨骨折的患者,以评估IV级和I/II级中心入院的结果。结果:在研究期间共收治了1070例孤立性肋骨骨折患者。IV级中心评估了360例患者,其中132例(36.6%)和228例(63.3%)在标准前后的改变期。孤立性肋骨骨折的移植显著减少(56%比21% p < 0.01)。与三次或少于三次肋骨骨折的患者相比,三次以上骨折的患者住院时间相似(中位数[四分位间距(IQR)], 3[2-5]对2 [1-4];P = 0.29)和死亡率(0%对2.3%,P = 0.22)。倾向匹配后,年龄无差异(中位数[IQR], 71 [60-81] vs. 73 [65-85];p = 0.24)、损伤特征、住院时间(中位数[IQR], 2.5[2-5]对2 [1-4];P = 0.37)和死亡率(1.7% vs. 0%, P = 0.30)。结论:国家住院标准的改变减少了三次以上孤立性肋骨骨折患者的转移。在一组超过三根肋骨骨折的匹配患者中,IV级中心与I级或II级中心的结果相似。证据水平:临床研究、回顾性研究;第三层次。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
6.00
自引率
11.80%
发文量
637
审稿时长
2.7 months
期刊介绍: The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信