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. 2017 Jan 13;7(1):e013029.
doi: 10.1136/bmjopen-2016-013029.

Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study

Sai-Wai Ho  1   2   3 , Ying-Hock Teng  2   3 , Shun-Fa Yang  1   4 , Han-Wei Yeh  5 , Yu-Hsun Wang  4 , Ming-Chih Chou  1   6 , Chao-Bin Yeh  2   3
Affiliations

Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study

Sai-Wai Ho et al. BMJ Open. .

Abstract

Objectives: Isolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas.

Design: Nationwide population-based cohort study.

Setting: Patients with IMRFs were identified between 2010 and 2011 from the Taiwan National Health Insurance Research Database.

Participants: Non-traumatic patients were matched through 1:8 propensity-score matching according to age, sex, and comorbidities (namely diabetes, hypertension, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD)) with the comparison cohort. We estimated the adjusted HRs (aHRs) by using the Cox proportional hazard model. A total of 709 patients with IMRFs and 5672 non-traumatic patients were included.

Main outcome measure: The primary end point was the occurrence of pneumonia within 30 days.

Results: The incidence of pneumonia following IMRFs was 1.6% (11/709). The aHR for the risk of pneumonia after IMRFs was 8.94 (95% CI=3.79 to 21.09, p<0.001). Furthermore, old age (≥65 years; aHR=5.60, 95% CI 1.97 to 15.89, p<0.001) and COPD (aHR=5.41, 95% CI 1.02 to 3.59, p<0.001) were risk factors for pneumonia following IMRFs. In the IMRF group, presence of single or two isolated rib fractures was associated with an increased risk of pneumonia with aHRs of 3.97 (95% CI 1.09 to 14.44, p<0.001) and 17.13 (95% CI 6.66 to 44.04, p<0.001), respectively.

Conclusions: Although the incidence of pneumonia following IMRFs is low, patients with two isolated rib fractures were particularly susceptible to pneumonia. Physicians should focus on this complication, particularly in elderly patients and those with COPD.

Keywords: Isolated minor rib fractures; blunt chest trauma; nationwide cohort study; pneumonia.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow chart for selecting patients with isolated minor rib fractures. COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Time elapsed between rib fractures and development of pneumonia. IMRF, isolated minor rib fractures.
Figure 3
Figure 3
Kaplan-Meier curves of the cumulative incidence of pneumonia in patients with isolated rib fractures and non-traumatic patients.
See this image and copyright information in PMC

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