Factors affecting mortality in trauma patients with more than three rib fractures

Abstract

Background: In patients with rib fractures, a higher number of rib fractures has been reported to increase the risk of mortality. This study aimed to explore the risk factors for mortality in patients with more than three rib fractures.Materials and Methods: This retrospective study involved a data review of 35,154 trauma patients registered in the Trauma Registry System of a single urban trauma center in Taiwan from January 1, 2009, to December 31, 2018. In total, 1,296 patients who had more than three rib fractures were identified and categorized into two groups: mortality (n = 42) and survival (n = 1,254). Univariate and multivariate logistic regression analyses were applied to identify the independent effects of predictive variables of mortality in patients with multiple rib fractures.Results: Patients who died had a significantly higher number of rib fractures (6.9 ± 3.0 vs. 5.5 ± 1.7, P < 0.001), lower Glasgow Coma Scale (GCS) score (median [interquartile range, Q1–Q3]; 12.5 [3–15] vs. 15.0 [15–15], P < 0.001), and higher injury severity score (ISS) (median [Q1–Q3]; 35.0 [26–41] vs. 16.0 [13–22], P < 0.001) than those who survived. The mortality group had a 10.4-, 3.8-, and 2.9-fold higher odds of sustaining a sternal fracture, pulmonary contusion, and hemopneumothorax, respectively. Multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.05–1.12; P < 0.001), number of rib fractures (OR, 1.2; 95% CI, 1.04–1.47; P = 0.016), GCS (OR, 0.8; 95% CI, 0.76–0.93; P = 0.001), ISS (OR, 1.2; 95% CI, 1.10–1.21; P < 0.001), blood transfusion (OR, 4.3; 95% CI, 1.37–13.40; P = 0.013), and hemopneumothorax (OR, 15.5; 95% CI, 2.769–86.62; P = 0.002) were the significant independent risk factors for mortality.Conclusion: This study revealed that age, number of rib fractures, GCS, ISS, blood transfusion, and hemopneumothorax were the significant independent risk factors for mortality of the patients with more than three rib fractures.