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Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study.
BMJ Open 2017; 7(1):e013029BO

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.

Authors+Show Affiliations

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan. Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan. Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.School of Medicine, Chang Gung University, Taoyuan City, Taiwan.Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan. Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28087547

Citation

Ho, Sai-Wai, et al. "Risk of Pneumonia in Patients With Isolated Minor Rib Fractures: a Nationwide Cohort Study." BMJ Open, vol. 7, no. 1, 2017, pp. e013029.
Ho SW, Teng YH, Yang SF, et al. Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study. BMJ Open. 2017;7(1):e013029.
Ho, S. W., Teng, Y. H., Yang, S. F., Yeh, H. W., Wang, Y. H., Chou, M. C., & Yeh, C. B. (2017). Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study. BMJ Open, 7(1), pp. e013029. doi:10.1136/bmjopen-2016-013029.
Ho SW, et al. Risk of Pneumonia in Patients With Isolated Minor Rib Fractures: a Nationwide Cohort Study. BMJ Open. 2017 01 13;7(1):e013029. PubMed PMID: 28087547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study. AU - Ho,Sai-Wai, AU - Teng,Ying-Hock, AU - Yang,Shun-Fa, AU - Yeh,Han-Wei, AU - Wang,Yu-Hsun, AU - Chou,Ming-Chih, AU - Yeh,Chao-Bin, Y1 - 2017/01/13/ PY - 2017/1/15/entrez PY - 2017/1/15/pubmed PY - 2017/12/9/medline KW - Isolated minor rib fractures KW - blunt chest trauma KW - nationwide cohort study KW - pneumonia SP - e013029 EP - e013029 JF - BMJ open JO - BMJ Open VL - 7 IS - 1 N2 - 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. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/28087547/Risk_of_pneumonia_in_patients_with_isolated_minor_rib_fractures:_a_nationwide_cohort_study_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&amp;pmid=28087547 DB - PRIME DP - Unbound Medicine ER -