Rib fractures: comparison of associated injuries between pediatric and adult population

• Published in: The American journal of surgery Vol. 208; no. 5; pp. 831 - 834
• Main Authors: Kessel, Boris, M.D, Dagan, Jasmin, M.D, Swaid, Forat, M.D, Ashkenazi, Itamar, M.D, Olsha, Oded, M.D, Peleg, Kobi, Ph.D., M.P.H, Givon, Adi, B.A, Alfici, Ricardo, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014; Elsevier Limited
• Subjects: Abdomen; Abdominal Injuries - epidemiology; Abdominal Injuries - etiology; Adolescent; Adult; Age; Age Factors; Associated injuries; Blunt trauma; Child; Child, Preschool; Cohort Studies; Craniocerebral Trauma - epidemiology; Craniocerebral Trauma - etiology; Humans; Incidence; Infant; Infant, Newborn; Injuries; Injury Severity Score; Israel - epidemiology; Middle Aged; Mortality; Multiple Trauma - epidemiology; Multiple Trauma - etiology; Pattern of injury; Pediatrics; Retrospective Studies; Rib fractures; Rib Fractures - mortality; Risk Factors; Studies; Surgery; Thoracic Injuries - epidemiology; Thoracic Injuries - etiology; Traffic accidents & safety; Trauma; Trauma centers; Vehicles; Wounds, Nonpenetrating - epidemiology; Wounds, Nonpenetrating - etiology; Young Adult; Israel; Blunt trauma; Rib fractures; Pattern of injury; Associated injuries
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2013.10.033

Abstract Background Rib fractures are considered a marker of exposure to significant traumatic energy. In children, because of high elasticity of the chest wall, higher energy levels are necessary for ribs to fracture. The purpose of this study was to analyze patterns of associated injuries in children as compared with adults, all of whom presented with rib fractures. Methods A retrospective cohort study involving blunt trauma patients with rib fractures registered in the National Trauma Registry was conducted. Results Of 6,995 trauma victims who were found to suffer from rib fractures, 328 were children and 6,627 were adults. Isolated rib fractures without associated injuries occurred in 19 children (5.8%) and 731 adults (11%). More adults had 4 or more fractured ribs compared with children ( P < .001). Children suffered from higher rates of associated brain injuries ( P = .003), hemothorax/pneumothorax ( P = .006), spleen, and liver injury ( P < .001). Mortality rate was 5% in both groups. Conclusions The incidence of associated head, thoracic, and abdominal solid organ injuries in children was significantly higher than in adults suffering from rib fractures. In spite of a higher Injury Severity Score and incidence of associated injuries, mortality rate was similar. Mortality of rib fracture patients was mostly affected by the presence of extrathoracic injuries.