ACOS 2024 Annual Clinical Assembly
General Surgery
Hason Khan, MS
Medical Student
Kansas City University
Kansas City University
Designed and validated in 2015, RibScore is a 6-point scoring system that was introduced by using only radiographic findings based on chest wall trauma to predict adverse pulmonary outcomes. One point is given to each of the following variables: > 6 rib Fractures, bilateral Fractures, flail Chest, > 3 bicortical displaced fractures, first rib fracture, fractures in all 3 anatomical areas (anterior, lateral, posterior)
The benefit of using only computed tomography (CT) findings provides an objective scoring system. Surgical stabilization of rib fractures (SSRF) is currently an option for patients to improve pain scores, decrease ventilator days, risk of ventilator-associated pneumonia, tracheostomy need, hospitalization, and overall mortality. Currently, there are no studies exploring the outcomes predicted by RibScore after SSRF.
Methods or Case Description:
This is an IRB approved retrospective review of all SSRF patients at a level 1 trauma center from 1/2017 to 4/2023. Patients under 18 years of age were excluded. CT imaging studies were reviewed, and each patient was given a score based on the Rib-Score criteria.
To assess adverse pulmonary outcomes, we used the following variables: pneumonia, respiratory Failure (need for mechanical ventilation post-SSRF >48h), and tracheostomy. Our primary outcome was the incidence of adverse pulmonary outcomes stratified by each RibScore after SSRF. Linear trend between the categorical dependent variable (RibScore) and each of the adverse pulmonary outcome variables using the Mantel-Haenszel test for trend.
Outcomes:
Our study found a total of 452 patients with a median age of 60 (47, 70). 314 patients (66.5%) were male and 138 (29.2%) were female. 444 patients (94.1%) experienced blunt trauma and 6 (1.3%) penetrating trauma. The total median days was 10 (7, 14), total medial ICU days was 4 (2,8), total median ICU days 4 (2,8), total median ventilator days 4 (2.5, 10), median ISS 14, and median chest AIS was 3.
Below is incidence of outcomes after SSRF per RibScore.
Rib Score | N | Trach. (N) | % with Trach. | Pneumonia (N) | % with Pneumonia | Resp. Failure (N) | % with Resp. Failure |
0 | 71 | 0 | 0 | 1 | 1.4 | 3 | 4.2 |
1 | 82 | 2 | 2.4 | 3 | 3.7 | 5 | 6.1 |
2 | 87 | 1 | 1.1 | 2 | 2.3 | 4 | 4.6 |
3 | 109 | 4 | 3.7 | 8 | 7.3 | 21 | 19.3 |
4 | 49 | 3 | 6.1 | 6 | 12.2 | 10 | 20.4 |
5 | 33 | 4 | 12.1 | 9 | 27.3 | 11 | 33.3 |
6 | 20 | 1 | 4.8 | 3 | 14.3 | 8 | 38.1 |
Chi-Squared | P = 0.039 | P < 0.001 | P < 0.001 | ||||
Linear by Linear Association | P = 0.003 | P < 0.001 | P < 0.001 | ||||
Conclusion:
This study demonstrated a statistically significant linear increase for each adverse pulmonary outcome in each subsequent RibScore after SSRF. Moreover, patients after having SSRF had significantly less incidence of adverse pulmonary outcomes when compared to the original pulmonary outcomes in the RibScore. Although additional studies are needed to confirm our results, SSRF improves pulmonary outcomes when compared to the original RibScore which can further be used to prognosticate chest wall injury outcomes.