Araştırma Makalesi
BibTex RIS Kaynak Göster

Kot kırıkları sonrası komplikasyonlar ve opioid kullanımı gerekliliği, 1074 hastanın analizi

Yıl 2021, , 352 - 356, 24.05.2021
https://doi.org/10.16899/jcm.887539

Öz

Amaç: Bu çalışma, kaburga kırıklarının risk faktörlerini, ilişkili komplikasyonları, opioid gereksinimini ve ölüm oranlarını değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntem: 1 Ocak 2016 ile 30 Eylül 2020 tarihleri arasında acil servise başvuran ve kot kırığı olan hastalar retrospektif olarak incelendi. Hastaların demografik verileri, kot kırığının özellikleri, travma mekanizması, ilişkili komplikasyonlar, hastanede kalış süreleri ve hastane içi mortalite kaydedildi.
Bulgular: Çalışmaya toplam 1074 hasta dahil edildi. Hastaların çoğu erkekti (n = 748, %69.6) ve ortalama yaş 53.89 ± 15.31 yıldı. Ortalama kırık kot sayısı 3.65 ± 2.06 idi. Diyafram yırtığı, atelektazi, pnömoni, ARDS, pnömomediasten, akciğer herniasyonu, yelken göğüs ve ampiyemi olan tüm hastalarda altı veya daha fazla kot kırığı vardı. Ölen ve hayatta kalan hastaların karşılaştırılmasında, yaş, cinsiyet, kaburga kırığı tarafı, kırık kaburga sayısı ve eşlik eden başka bir organ yaralanması açısından istatistiksel olarak anlamlı farklılıklar mevcuttu. Kırık kot sayısı ile pnömotoraks, hemotoraks, göğüs tüpü, opioid kullanımı ve hastanede kalış süresi arasında orta-güçlü bir korelasyon bulundu.
Sonuç: Kırık kot sayısının artması, artan komplikasyonlar, opioid kullanımı ve hastanede kalış süresi ile ilişkiliydi. Altı ve daha fazla kırığı olan hastalarda ölüm oranı %8.8 idi. Araç içi trafik kazaları en yaygın mekanizmaydı. Tedbirler iyileştirilirse kot kırıklarının büyük bir kısmı önlenebilir.

Kaynakça

  • References 1. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma 1994;37(6):975-9.
  • 2. Jensen CD, Stark JT, Jacobson LL, et al. Improved Outcomes Associated with the Liberal Use of Thoracic Epidural Analgesia in Patients with Rib Fractures. Pain Med 2017;18(9):1787-94.
  • 3. Weiser TG. Overview of thoracic trauma. In: Merck Manual Professional Version. Kenilworth, New Jersey: Merck; 2014.
  • 4. Pines G, Gotler Y, Lazar LO, Lin G. Clinical significance of rib fractures' anatomical patterns. Injury 2020;51(8):1812-6.
  • 5. Katrancioglu O, Akkas Y, Arslan S, Sahin E. Spontaneous rib fractures. Asian Cardiovasc Thorac Ann 2015;23(6):701-3.
  • 6. Talbot BS, Gange CP Jr, Chaturvedi A, Klionsky N, Hobbs SK, Chaturvedi A. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment. Radiographics 2017;37(2):628-51.
  • 7. Gupta A, Jamshidi M, Rubin JR. Traumatic first rib fracture: is angiography necessary? A review of 730 cases. Cardiovasc Surg 1997;5(1):48-53.
  • 8. Park S. Clinical Analysis for the Correlation of Intra-abdominal Organ Injury in the Patients with Rib Fracture. Korean J Thorac Cardiovasc Surg 2012;45(4):246-50.
  • 9. Al-Hassani A, Abdulrahman H, Afifi I, et al. Rib fracture patterns predict thoracic chest wall and abdominal solid organ injury. Am Surg 2010;76(8):888-91.
  • 10. Sharma OP, Oswanski MF, Jolly S, Lauer SK, Dressel R, Stombaugh HA. Perils of rib fractures. Am Surg 2008;74(4):310-4.
  • 11. Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery 2005t;138(4):717-23.
  • 12. 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.
  • 13. Ivey KM, White CE, Wallum TE, et al. Thoracic injuries in US combat casualties: a 10-year review of Operation Enduring Freedom and Iraqi Freedom. J Trauma Acute Care Surg 2012;73:S514-9.
  • 14. Shweiki E, Klena J, Wood GC, Indeck M. Assessing the true risk of abdominal solid organ injury in hospitalized rib fracture patients. J Trauma 2001;50(4):684-8.
  • 15. Holmes JF, Ngyuen H, Jacoby RC, McGahan JP, Bozorgchami H, Wisner DH. Do all patients with left costal margin injuries require radiographic evaluation for intraabdominal injury? Ann Emerg Med 2005;46(3):232-6.
  • 16. Livoni JP, Barcia TC. Fracture of the first and second rib: incidence of vascular injury relative to type of fracture. Radiology 1982;145(1):31-3.
  • 17. Ciraulo DL, Elliott D, Mitchell KA, Rodriguez A. Flail chest as a marker for significant injuries. J Am Coll Surg 1994;178(5):466-70.
  • 18. Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg 2014;76(2):462-8.
  • 19. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040-6.
  • 20. Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma 2003;54(3):478-85.
  • 21. Lee RB, Bass SM, Morris JA Jr, MacKenzie EJ. Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma 1990;30(6):689-94.
  • 22. Crandall J, Kent R, Patrie J, Fertile J, Martin P. Rib fracture patterns and radiologic detection--a restraint-based comparison. Annu Proc Assoc Adv Automot Med 2000;44:235-59.
  • 23. 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.
  • 24. Yang Y, Young JB, Schermer CR, Utter GH. Use of ketorolac is associated with decreased pneumonia following rib fractures. Am J Surg 2014;207(4):566-72.
  • 25. Dalton MK, Chaudhary MA, Andriotti T, et al. Patterns and predictors of opioid prescribing and use after rib fractures. Surgery 2020;168(4):684-9.
  • 26. Harrington DT, Phillips B, Machan J, et al. Factors associated with survival following blunt chest trauma in older patients: results from a large regional trauma cooperative. Arch Surg 2010;145(5):432-7.

Complications, and requirement of opioid use after rib fractures, an analysis of 1074 patients

Yıl 2021, , 352 - 356, 24.05.2021
https://doi.org/10.16899/jcm.887539

Öz

Aim: This study was aimed to evaluate the risk factors, associated complications, opioid requirements, and mortality rates of rib fractures.
Materials and Methods: Patients with rib fractures who were admitted to the emergency department between January 1, 2016, and December 31, 2020, were retrospectively analyzed. Patients' demographic data, rib fracture characteristics, trauma mechanism, associated complications, length of stay in the hospital, and in-hospital mortality were recorded.
Results: A total of 1074 patients were included in the study. Most of the patients were male (n = 748, 69.6%) and the mean age was 53.89 ± 15.31 years. The mean number of fractured ribs was 3.65 ± 2.06. All patients with diaphragm laceration, atelectasis, pneumonia, ARDS, pneumomediastinum, lung herniation, flail chest, and empyema had six or more rib fractures. Comparison of died and survived patients showed statistically significant differences for age, gender, side of rib fracture, number of fractured ribs, and accompanying another organ injury. A moderate-strong correlation was found between the number of fractured ribs and pneumothorax, hemothorax, chest tube, opioid use, and length of stay in the hospital.
Conclusion: Increased number of fractured ribs were associated with increased complications, opioid use, and length of stay in the hospital. The mortality rate was 8.8% in patients with 6 or more fractures. In-vehicle traffic accidents were the most common mechanism. Many of the rib fractures can be prevented if the measures are improved.

Kaynakça

  • References 1. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma 1994;37(6):975-9.
  • 2. Jensen CD, Stark JT, Jacobson LL, et al. Improved Outcomes Associated with the Liberal Use of Thoracic Epidural Analgesia in Patients with Rib Fractures. Pain Med 2017;18(9):1787-94.
  • 3. Weiser TG. Overview of thoracic trauma. In: Merck Manual Professional Version. Kenilworth, New Jersey: Merck; 2014.
  • 4. Pines G, Gotler Y, Lazar LO, Lin G. Clinical significance of rib fractures' anatomical patterns. Injury 2020;51(8):1812-6.
  • 5. Katrancioglu O, Akkas Y, Arslan S, Sahin E. Spontaneous rib fractures. Asian Cardiovasc Thorac Ann 2015;23(6):701-3.
  • 6. Talbot BS, Gange CP Jr, Chaturvedi A, Klionsky N, Hobbs SK, Chaturvedi A. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment. Radiographics 2017;37(2):628-51.
  • 7. Gupta A, Jamshidi M, Rubin JR. Traumatic first rib fracture: is angiography necessary? A review of 730 cases. Cardiovasc Surg 1997;5(1):48-53.
  • 8. Park S. Clinical Analysis for the Correlation of Intra-abdominal Organ Injury in the Patients with Rib Fracture. Korean J Thorac Cardiovasc Surg 2012;45(4):246-50.
  • 9. Al-Hassani A, Abdulrahman H, Afifi I, et al. Rib fracture patterns predict thoracic chest wall and abdominal solid organ injury. Am Surg 2010;76(8):888-91.
  • 10. Sharma OP, Oswanski MF, Jolly S, Lauer SK, Dressel R, Stombaugh HA. Perils of rib fractures. Am Surg 2008;74(4):310-4.
  • 11. Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery 2005t;138(4):717-23.
  • 12. 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.
  • 13. Ivey KM, White CE, Wallum TE, et al. Thoracic injuries in US combat casualties: a 10-year review of Operation Enduring Freedom and Iraqi Freedom. J Trauma Acute Care Surg 2012;73:S514-9.
  • 14. Shweiki E, Klena J, Wood GC, Indeck M. Assessing the true risk of abdominal solid organ injury in hospitalized rib fracture patients. J Trauma 2001;50(4):684-8.
  • 15. Holmes JF, Ngyuen H, Jacoby RC, McGahan JP, Bozorgchami H, Wisner DH. Do all patients with left costal margin injuries require radiographic evaluation for intraabdominal injury? Ann Emerg Med 2005;46(3):232-6.
  • 16. Livoni JP, Barcia TC. Fracture of the first and second rib: incidence of vascular injury relative to type of fracture. Radiology 1982;145(1):31-3.
  • 17. Ciraulo DL, Elliott D, Mitchell KA, Rodriguez A. Flail chest as a marker for significant injuries. J Am Coll Surg 1994;178(5):466-70.
  • 18. Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg 2014;76(2):462-8.
  • 19. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040-6.
  • 20. Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma 2003;54(3):478-85.
  • 21. Lee RB, Bass SM, Morris JA Jr, MacKenzie EJ. Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma 1990;30(6):689-94.
  • 22. Crandall J, Kent R, Patrie J, Fertile J, Martin P. Rib fracture patterns and radiologic detection--a restraint-based comparison. Annu Proc Assoc Adv Automot Med 2000;44:235-59.
  • 23. 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.
  • 24. Yang Y, Young JB, Schermer CR, Utter GH. Use of ketorolac is associated with decreased pneumonia following rib fractures. Am J Surg 2014;207(4):566-72.
  • 25. Dalton MK, Chaudhary MA, Andriotti T, et al. Patterns and predictors of opioid prescribing and use after rib fractures. Surgery 2020;168(4):684-9.
  • 26. Harrington DT, Phillips B, Machan J, et al. Factors associated with survival following blunt chest trauma in older patients: results from a large regional trauma cooperative. Arch Surg 2010;145(5):432-7.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Araştırma
Yazarlar

Ahmet Çağlar 0000-0002-0161-1167

Mehmet Ali Eryazğan 0000-0002-9513-4380

Kemal Öztürk 0000-0001-7555-4209

İlker Kaçer 0000-0002-9653-7958

Yayımlanma Tarihi 24 Mayıs 2021
Kabul Tarihi 17 Mart 2021
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

AMA Çağlar A, Eryazğan MA, Öztürk K, Kaçer İ. Complications, and requirement of opioid use after rib fractures, an analysis of 1074 patients. J Contemp Med. Mayıs 2021;11(3):352-356. doi:10.16899/jcm.887539