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Testing the clinical validity of the Bemelman Rib Fracture Management Guideline.

Abstract

Whilst surgical stabilization of rib fractures (SSRF) results in better outcomes, selection algorithms are lacking. We aimed to validate the Rib Fracture Management Guideline proposed by Bemelman. From a cohort of 792 patients with multiple rib fractures, 2 sequential cohorts were selected: 48 patients who underwent SSRF and 48 patients who managed conservatively. Admission computed tomography scans and records were reviewed by an investigator blinded to the SSRF outcome. Adherence to the Bemelman guideline, revised to take account of consensus rib fracture definitions, was tested. Fifty-seven patients had multiple rib fractures only, and 39 patients also had a flail segment. Thirty-nine patients with flail segment underwent SSRF, and 18 patients were managed conservatively. Of the patients that the guideline predicted should have received surgery, 87% did. Of those that it predicted should not receive SSRF, 98% did not. The guideline displayed a sensitivity (95% confidence interval) and specificity for predicting the fixation of 0.98 (0.89-0.9995) and 0.83 (0.70-0.93), respectively. The positive and negative predictive values for surgical fixation were 0.87 (0.76-0.92) and 0.98 (0.85-0.99), respectively. The Bemelman guideline was thus a good predictor of SSRF in retrospective cohort but should be used in conjunction with clinical judgement. Further validation is indicated in a prospective study.

Authors+Show Affiliations

Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. The Medical School, University of Sheffield, Sheffield, UK.Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. The Medical School, University of Sheffield, Sheffield, UK.Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. The Medical School, University of Sheffield, Sheffield, UK.Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31971227

Citation

Dorman, Jessica R., et al. "Testing the Clinical Validity of the Bemelman Rib Fracture Management Guideline." Interactive Cardiovascular and Thoracic Surgery, 2020.
Dorman JR, Clarke PTM, Simpson RB, et al. Testing the clinical validity of the Bemelman Rib Fracture Management Guideline. Interact Cardiovasc Thorac Surg. 2020.
Dorman, J. R., Clarke, P. T. M., Simpson, R. B., & Edwards, J. G. (2020). Testing the clinical validity of the Bemelman Rib Fracture Management Guideline. Interactive Cardiovascular and Thoracic Surgery, doi:10.1093/icvts/ivz317.
Dorman JR, et al. Testing the Clinical Validity of the Bemelman Rib Fracture Management Guideline. Interact Cardiovasc Thorac Surg. 2020 Jan 23; PubMed PMID: 31971227.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Testing the clinical validity of the Bemelman Rib Fracture Management Guideline. AU - Dorman,Jessica R, AU - Clarke,Peter T M, AU - Simpson,Rosalind B, AU - Edwards,John G, Y1 - 2020/01/23/ PY - 2019/10/14/received PY - 2019/12/06/revised PY - 2019/12/19/accepted PY - 2020/1/24/entrez KW - Flail chest KW - Rib fractures KW - Surgical stabilization of rib fractures JF - Interactive cardiovascular and thoracic surgery JO - Interact Cardiovasc Thorac Surg N2 - Whilst surgical stabilization of rib fractures (SSRF) results in better outcomes, selection algorithms are lacking. We aimed to validate the Rib Fracture Management Guideline proposed by Bemelman. From a cohort of 792 patients with multiple rib fractures, 2 sequential cohorts were selected: 48 patients who underwent SSRF and 48 patients who managed conservatively. Admission computed tomography scans and records were reviewed by an investigator blinded to the SSRF outcome. Adherence to the Bemelman guideline, revised to take account of consensus rib fracture definitions, was tested. Fifty-seven patients had multiple rib fractures only, and 39 patients also had a flail segment. Thirty-nine patients with flail segment underwent SSRF, and 18 patients were managed conservatively. Of the patients that the guideline predicted should have received surgery, 87% did. Of those that it predicted should not receive SSRF, 98% did not. The guideline displayed a sensitivity (95% confidence interval) and specificity for predicting the fixation of 0.98 (0.89-0.9995) and 0.83 (0.70-0.93), respectively. The positive and negative predictive values for surgical fixation were 0.87 (0.76-0.92) and 0.98 (0.85-0.99), respectively. The Bemelman guideline was thus a good predictor of SSRF in retrospective cohort but should be used in conjunction with clinical judgement. Further validation is indicated in a prospective study. SN - 1569-9285 UR - https://www.unboundmedicine.com/medline/citation/31971227/Testing_the_clinical_validity_of_the_Bemelman_Rib_Fracture_Management_Guideline L2 - https://academic.oup.com/icvts/article-lookup/doi/10.1093/icvts/ivz317 DB - PRIME DP - Unbound Medicine ER -