title: Increasing number of fractured ribs is not predictive of the severity of splenic injury following blunt trauma: an analysis of a National Trauma Registry database.
abstract: BACKGROUND
  Association between rib fractures and incidence of abdominal solid organs injury is well described. However, the correlation between the number of fractured ribs and severity of splenic injury is not clear. The purpose of this study was to assess whether an increasing number of rib fractures predicts the severity of splenic injury in blunt trauma patients.
  
  
  METHODS
  A retrospective cohort study involving blunt trauma patients with concomitant splenic injuries and rib fractures, between the years 1998 and 2012, registered in the Israeli National Trauma Registry.
  
  
  RESULTS
  Of 321,618 patients with blunt mechanism of trauma, 57,130 had torso injuries, and of these 14,651 patients sustained rib fractures, and 3691 patients suffered from splenic injury. Concomitant splenic injury occurred in 1326 of the patients with rib fractures (9.1%), as compared to 2365 patients sustaining splenic injury without rib fractures (5.6%). The incidence of splenic injury among patients sustaining 5 or more rib fractures was significantly higher compared to patients suffering from 1 to 4 rib fractures. Among patients with splenic injury, the tendency to sustain associated rib fractures increased steadily with age. Patients with concomitant rib fractures had higher Injury Severity Score (ISS), but similar mortality rates, compared to patients with splenic injury without rib fractures. Among patients with concomitant rib fractures and splenic injury, there was no relation between the number of fractured ribs and the severity of splenic injury, neither as a whole group, nor after stratification according to the mechanism of injury.
  
  
  CONCLUSIONS
  Although the presence of rib fractures increases the probability of splenic injury in blunt torso trauma, there is no relation between the number of fractured ribs and splenic injury severity.
authors.affiliation: Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel. Electronic address: blko2@yahoo.com.
authors.forename: Kessel
authors.initials: K
authors.lastname: Boris
authors.affiliation: General Surgery Department, Bnai-Zion Medical Center, Haifa, Israel.
authors.forename: Swaid
authors.initials: S
authors.lastname: Forat
authors.affiliation: Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: Ashkenazi
authors.initials: A
authors.lastname: Itamar
authors.affiliation: Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Olsha
authors.initials: O
authors.lastname: Oded
authors.affiliation: National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
authors.forename: Peleg
authors.initials: P
authors.lastname: Kobi
authors.affiliation: National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
authors.forename: Givon
authors.initials: G
authors.lastname: Adi
authors.affiliation: Trauma Unit, Assaf Harofeh Medical Center, Israel.
authors.forename: Jeroukhimov
authors.initials: J
authors.lastname: Igor
authors.affiliation: Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: Alfici
authors.initials: A
authors.lastname: Ricardo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007557:Israel; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012253:Rib Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D013154:Spleen / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: Blunt abdominal trauma; Mechanism of injury; Rib fractures; Splenic injury