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Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury.

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Surgical stabilization versus nonoperative treatment for flail and non-flail rib fracture patterns in patients with traumatic brain injury. European journal of trauma and emergency surgery : official publication of the European Trauma Society Prins, J. T., Van Lieshout, E. M., Ali-Osman, F., Bauman, Z. M., Caragounis, E. C., Choi, J., Christie, D. B., Cole, P. A., DeVoe, W. B., Doben, A. R., Eriksson, E. A., Forrester, J. D., Fraser, D. R., Gontarz, B., Hardman, C., Hyatt, D. G., Kaye, A. J., Ko, H. J., Leasia, K. N., Leon, S., Marasco, S. F., McNickle, A. G., Nowack, T., Ogunleye, T. D., Priya, P., Richman, A. P., Schlanser, V., Semon, G. R., Su, Y. H., Verhofstad, M. H., Whitis, J., Pieracci, F. M., Wijffels, M. M. 2022

Abstract

Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale =?12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients.A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. The primary outcome was mechanical ventilation-free days and secondary outcomes were in-hospital outcomes. In multivariable analysis, outcomes were assessed, stratified for rib fracture pattern.In total, 449 patients were analyzed. In patients with a non-flail fracture pattern, 25 of 228 (11.0%) underwent SSRF and in patients with a flail chest, 86 of 221 (38.9%). In multivariable analysis, ventilator-free days were similar in both treatment groups. For patients with a non-flail fracture pattern, the odds of pneumonia were significantly lower after SSRF (odds ratio 0.29; 95% CI 0.11-0.77; p?=?0.013). In patients with a flail chest, the ICU LOS was significantly shorter in the SSRF group (beta, - 2.96 days; 95% CI - 5.70 to - 0.23; p?=?0.034).In patients with TBI and a non-flail fracture pattern, SSRF was associated with a reduced pneumonia risk. In patients with TBI and a flail chest, a shorter ICU LOS was observed in the SSRF group. In both groups, SSRF was safe and did not hamper neurological recovery.

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