title: The number of displaced rib fractures is more predictive for complications in chest trauma patients.
abstract: BACKGROUND
  Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increase in chest complications.
  
  
  METHODS
  We retrospectively reviewed the trauma registry between January 2013 and May 2015 in a teaching hospital in northeastern Taiwan. Patients admitted with chest trauma and rib fractures without concomitant severe brain, splenic, pelvic or liver injuries were included. The demographic data, such as gender, age, the index of coexistence disease, alcohol consumption, trauma mechanisms were analyzed as potential predictors of pulmonary complications. Pulmonary complications were defined as pneumothorax, hemothorax, flail chest, pulmonary contusion, and pneumonia.
  
  
  RESULTS
  In the 29 months of the study period, a total of 3151 trauma patients were admitted to our hospital. Among them, 174 patients were enrolled for final analysis. The most common trauma mechanism was road traffic accidents (58.6%), mainly motorbike accidents (n = 70, 40.2%). Three or more displaced rib fractures had higher specificity for predicting complications, compared to three or more total rib fractures (95.5% vs 59.1%). Adjusting the severity of chest trauma using TTSS and Ribscore by multivariable logistic regression analysis, we found that three or more rib fractures or any displaced rib fracture was the most significant predictor for developing pulmonary complication (aOR: 5.49 95% CI: 1.82-16.55). Furthermore, there were 18/57 (31.6%) patients with fewer than three ribs fractures developed pulmonary complications. In these 18 patients, only five patients had delayed onset complications and four of them had at least one displaced rib fracture.
  
  
  CONCLUSIONS
  In this retrospective cohort study, we found that the number of displaced or total rib fractures, bilateral rib fractures, and rib fractures in more than two areas were associated with the more chest complications. Furthermore, three or more rib fracture or any displacement were found to be the most sensitive risk factor for chest complications, independent of other risk factors or severity index.
  
  
  CONCLUSIONS
  The number of displaced rib fractures could be a strong predictor for developing pulmonary complications. For patients with fewer than three rib fractures without rib displacement and initial lung or other organ injuries, outpatient management could be safe and efficient.
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Chien
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Yu-Hsien
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Shih-Tsung
authors.initials: ST
authors.lastname: Han
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Gerald N
authors.initials: GN
authors.lastname: Blaney
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Ting-Shuo
authors.initials: TS
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. kfchen@cgmh.org.tw.|Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan. kfchen@cgmh.org.tw.|Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan. kfchen@cgmh.org.tw.
authors.forename: Kuan-Fu
authors.initials: KF
authors.lastname: Chen
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D012253:Rib Fractures / Q000503:physiopathology*; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013898:Thoracic Injuries / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications*
keywords: Chest Trauma; Complications; Displaced Rib Fractures; Hospitalization; Prognosis; Rib Fractures; Sensitivity and Specificity