title: Do simple beside lung function tests predict morbidity after rib fractures?
abstract: BACKGROUND
  We evaluated if incentive spirometry volume (ISV) and peak expiratory flow rate (PEFR) could predict acute respiratory failure (ARF) in patients with rib fractures.
  
  
  METHODS
  Normotensive, co-operative patients were enrolled prospectively. ISV and PEFR were measured on admission, at 24 h and at 48 h by taking the best of three readings each time. The primary outcome, ARF, was defined as requiring invasive or noninvasive positive pressure ventilation.
  
  
  RESULTS
  99 patients were enrolled (median age, 77 years). ARF occurred in 9%. Of the lung function tests, only a low median ISV at admission was associated with ARF (500 ml vs 1250 ml, p = 0.04). Three of 69 patients with ISV of ≥1000 ml versus six of 30 with ISV <1000 ml developed ARF (p = 0.01). Other significant factors were: number of rib fractures, tube thoracostomy, any lower-third rib fracture, flail segment.
  
  
  CONCLUSIONS
  PEFR did not predict ARF. Admission ISV may have value in predicting ARF.
authors.affiliation: Department of Surgery, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131, United States.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Butts
authors.affiliation: Department of Surgery, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131, United States.
authors.forename: John J
authors.initials: JJ
authors.lastname: Brady
authors.affiliation: Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States.
authors.forename: Sara
authors.initials: S
authors.lastname: Wilhelm
authors.affiliation: Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States.
authors.forename: Laura
authors.initials: L
authors.lastname: Castor
authors.affiliation: Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States.
authors.forename: Alicia
authors.initials: A
authors.lastname: Sherwood
authors.affiliation: Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States.
authors.forename: Abby
authors.initials: A
authors.lastname: McCall
authors.affiliation: Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States.
authors.forename: John
authors.initials: J
authors.lastname: Patch
authors.affiliation: Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States.
authors.forename: Pamela
authors.initials: P
authors.lastname: Jones
authors.affiliation: Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States.
authors.forename: Vicente
authors.initials: V
authors.lastname: Cortes
authors.affiliation: Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States. Electronic address: Adrian.Ong@readinghealth.org.
authors.forename: Adrian W
authors.initials: AW
authors.lastname: Ong
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D019095:Point-of-Care Systems; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012253:Rib Fractures / Q000150:complications*; D013147:Spirometry; D013907:Thoracostomy
keywords: Acute respiratory failure; Incentive spirometry; Peak expiratory flow rate; Rib fracture