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. 2022 Feb;48(1):231-241.
doi: 10.1007/s00068-020-01598-5. Epub 2021 Jan 26.

Iatrogenic rib fractures and the associated risks of mortality

Max R Coffey  1   2 , Katelynn C Bachman  1   2 , Vanessa P Ho  1   3 , Stephanie G Worrell  1   2 , Matthew L Moorman  1   2 , Philip A Linden  1   2 , Christopher W Towe  4   5
Affiliations

Iatrogenic rib fractures and the associated risks of mortality

Max R Coffey et al. Eur J Trauma Emerg Surg. 2022 Feb.

Abstract

Purpose: Rib fractures, though typically associated with blunt trauma, can also result from complications of medical or surgical care, including cardiopulmonary resuscitation. The purpose of this study is to describe the demographics and outcomes of iatrogenic rib fractures.

Methods: Patients with rib fractures were identified in the 2016 National Inpatient Sample. Mechanism of injury was defined as blunt traumatic rib fracture (BTRF) or iatrogenic rib fracture (IRF). IRF was identified as fractures from the following mechanisms: complications of care, drowning, suffocation, and poisoning. Differences between BTRF and IRF were compared using rank-sum test, Chi-square test, and multivariable regression.

Results: 34,644 patients were identified: 33,464 BTRF and 1180 IRF. IRF patients were older and had higher rates of many comorbid medical disorders. IRF patients were more likely to have flail chest (6.1% versus 3.1%, p < 0.001). IRF patients were more likely to have in-hospital death (20.7% versus 4.2%, p < 0.001) and longer length of hospitalization (11.8 versus 6.9 days, p < 0.001). IRF patients had higher rates of tracheostomy (30.2% versus 9.1%, p < 0.001). In a multivariable logistic regression of all rib fractures, IRF was independently associated with death (OR 3.13, p < 0.001). A propensity matched analysis of IRF and BTRF groups corroborated these findings.

Conclusion: IRF injuries are sustained in a subset of extremely ill patients. Relative to BTRF, IRF is associated with greater mortality and other adverse outcomes. This population is understudied. The etiology of worse outcomes in IRF compared to BTRF is unclear. Further study of this population could address this disparity.

Keywords: Cardiopulmonary resuscitation; Iatrogenesis; Iatrogenic rib fractures; Thoracic trauma.

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Figures

Figure 1:
Figure 1:
Age of BTRF patients versus IRF patients.
Figure 2:
Figure 2:
IRF patient mortality rate by age.
Figure 3:
Figure 3:
Effect of propensity matching on bias between the cohorts of patients with BTRF and IRF shown as Mahalonobis distance before and after propensity match.
See this image and copyright information in PMC

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