Factors Affecting Pneumonia Occurring to Patients with Multiple Rib Fractures.
10.5090/kjtcs.2013.46.2.130
- Author:
Joung Hun BYUN
1
;
Han Young KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Korea. jhunikr@naver.com
- Publication Type:Original Article
- Keywords:
Trauma;
Hemothorax
- MeSH:
Accidents, Occupational;
Accidents, Traffic;
Aged;
Anti-Bacterial Agents;
Chest Tubes;
Contusions;
Flail Chest;
Hemopneumothorax;
Hemothorax;
Hospital Mortality;
Humans;
Injury Severity Score;
Intensive Care Units;
Lung;
Male;
Multiple Trauma;
Multivariate Analysis;
Pneumonia;
Pneumothorax;
Retrospective Studies;
Rib Fractures;
Ribs;
Risk Factors;
Thoracic Cavity;
Thorax
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2013;46(2):130-134
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Rib fractures are the most common type of thoracic trauma and cause other complications. We explored the risk factors for pneumonia in patients with multiple rib fractures. MATERIALS AND METHODS: Four hundred and eighteen patients who visited our hospital with multiple rib fractures between January 2002 and December 2008 were retrospectively reviewed. Chest X-rays and chest computed tomography were used to identify injury severity. Patients with only a single rib fracture or who were transferred to another hospital within 2 days were excluded. RESULTS: There were 327 male patients (78%), and the median age was 53 years. The etiologies of the patients' trauma included traffic accidents in 164 cases (39%), falls in 78 cases (19%), slipping and falling in 90 (22%), pedestrian accidents in 30 (7%), industrial accidents in 41 (10%), and assault in 15 (4%). The median number of rib fractures was 4.8. Pulmonary complications including flail chest (2.3%), lung contusion (22%), hemothorax (62%), pneumothorax (31%), and hemopneumothorax (20%) occurred. Chest tubes were inserted into the thoracic cavity in 216 cases (52%), and the median duration of chest tube insertion was 10.26 days. The Injury Severity Score (ISS) and rib score had a median of 15.27 and 6.9, respectively. Pneumonia occurred in 18 cases (4.3%). Of the total cases, 33% of the cases were managed in the intensive care unit (ICU), and the median duration of stay in the ICU was 7.74 days. Antibiotics were administered in 399 patients (95%) for a median of 10.53 days. Antibiotics were used for more than 6 days in 284 patients (68%). The factors affecting pneumonia in patients with multiple rib fractures in multivariate analysis included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). The use of antibiotics was not associated with the occurrence of pneumonia (p=0.28). In-hospital mortality was 5.3% (n=22). CONCLUSION: The factors affecting risk of pneumonia in patients with multiple rib fractures included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). Elderly patients with multiple traumas have a high risk of pneumonia and should be treated accordingly.
