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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, January 5, 2016


Chapman B et al. Journal of Trauma and Acute Care Surgery 2016; 80 (1): 95–101
"Rib fractures are present in approximately 10% of trauma patients and are a marker of injury severity. Among patients with rib fractures, 90% will have associated injuries, 50% will require operative and intensive care unit care, 33% will develop pulmonary complications, 33% will require discharge to an extended care facility, and 12% die before hospital discharge. Factors associated with increased morbidity and mortality from rib fractures include age, number of rib fractures, flail chest, bilateral rib fractures pulmonary contusions, development of pneumonia, and preexisting comorbidities.
Rib fractures result in pulmonary embarrassment via several mechanisms. Pain results in splinting, atelectasis, and impaired clearance of secretions. Altered chest wall mechanics distort normal costovertebral and diaphragmatic muscle exertion. Finally, fracture fragments may penetrate the parietal pleura resulting in pneumothorax, hemothorax, and pulmonary parenchymal lacerations.
During the last several decades, substantial progress has been made in the management of patients with rib fractures, including locoregional anesthesia, pulmonary toilet, and rib-specific surgical stabilization systems. Allocation of these resources to patients with rib fractures should ideally be based on a validated, objective severity scoring system. Such a system would also assist in both prognostication and decisions regarding patient management. Finally, variables within the scoring system should be available for abstraction early in the patient’s course, be easily communicated to referral centers, and account for complexities in fracture patterns. Current chest injury scoring systems, such as the Rib Fracture Score (RFS), Organ Injury Scale (OIS) Chest Wall grade, and Chest Trauma Score (CTS), do not characterize fracture patterns beyond the number of fractures and bilaterality.
Our objective was to develop a radiographic rib fracture scoring system to both predict adverse pulmonary outcomes and guide therapeutic decision making specific to rib fractures, such as placement of epidural and paravertebral pain catheters and surgical stabilization of rib fractures (SSRF). We hypothesized that this scoring system, henceforth referred to as the RibScore, would predict pneumonia, respiratory failure, and tracheostomy."