Morbidity prediction in conservatively managed rib fracture patients.

IF 2.2 3区 医学 Q2 EMERGENCY MEDICINE
Lovisa Ekestubbe, Maximilian Peter Forssten, Yang Cao, Babak Sarani, Shahin Mohseni
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引用次数: 0

Abstract

Purpose: Rib fractures, common in blunt chest trauma, affect 10% of trauma patients and are linked to increased pulmonary morbidity and mortality. This study applies machine learning to identify predictors of complications in conservatively managed rib fracture patients.

Methods: Data from the 2013-2021 American College of Surgeons' Trauma Quality Improvement Program included adults (≥ 18 years) with isolated thoracic injury from blunt trauma and conservatively managed rib fractures. Variables included demographics, comorbidities, injury severity, injury patterns, admission vitals, and complications. The permutation importance method identified top predictors of in-hospital complications.

Results: Of 321,355 rib fracture patients, 183,303 (57.0%) had isolated rib fractures. The five primary predictors of complications in all rib fracture patients were age, Glasgow Coma Scale (GCS) on admission, Revised Cardiac Risk Index (RCRI), chronic obstructive pulmonary disease (COPD), and alcohol use disorder. For isolated rib fracture patients, the same predictors applied but in the order: age, RCRI, GCS, COPD, and alcohol use disorder. A logistic regression model using these predictors showed acceptable discriminative capacity for complications in the full cohort [AUC (95% CI): 0.72 (0.71-0.72)] and isolated rib fracture patients [AUC (95% CI): 0.72 (0.71-0.73)].

Conclusion: Cardiovascular risk, age, and level of consciousness on admission are key predictors of complications in conservatively managed rib fracture patients. Though complication rates remain low overall, elderly patients with multiple cardiovascular risk factors face a heightened risk of deterioration.

Abstract Image

Abstract Image

保守治疗肋骨骨折患者的发病率预测。
目的:肋骨骨折在钝性胸部创伤中很常见,影响10%的创伤患者,并与肺部发病率和死亡率增加有关。本研究应用机器学习识别保守治疗肋骨骨折患者并发症的预测因素。方法:来自2013-2021年美国外科医师学会创伤质量改善项目的数据包括单纯胸部钝性创伤和保守治疗肋骨骨折的成年人(≥18岁)。变量包括人口统计学、合并症、损伤严重程度、损伤模式、入院生命体征和并发症。排列重要性法确定院内并发症的主要预测因素。结果:321355例肋骨骨折患者中,183303例(57.0%)为孤立性肋骨骨折。所有肋骨骨折患者并发症的五个主要预测因素是年龄、入院时格拉斯哥昏迷量表(GCS)、修订心脏风险指数(RCRI)、慢性阻塞性肺疾病(COPD)和酒精使用障碍。对于孤立性肋骨骨折患者,适用相同的预测因子,但顺序为:年龄、RCRI、GCS、COPD和酒精使用障碍。使用这些预测因子的logistic回归模型显示,在全队列中[AUC (95% CI): 0.72(0.71-0.72)]和孤立性肋骨骨折患者中[AUC (95% CI): 0.72(0.71-0.73)],并发症的判别能力是可以接受的。结论:心血管风险、年龄和入院时的意识水平是保守治疗肋骨骨折患者并发症的关键预测因素。尽管总体上并发症发生率仍然很低,但具有多种心血管危险因素的老年患者面临着更高的恶化风险。
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来源期刊
CiteScore
4.50
自引率
14.30%
发文量
311
审稿时长
3 months
期刊介绍: The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries. Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.
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