Marini et al reported factors associated with mortality in a patient with rib fractures. These can help to identify a patient with rib fractures who may require more aggressive management. The authors are from New York Medical College and NYU Long Island School of Medicine.

Patient selection: patient with rib fractures. >= 16 years of age


Mechanisms of injury: motor vehicle, falls


Factors predictive of mortality in the multivariate analysis:

(1) age in years (odds ratio 1.06)

(2) male gender (odds ratio 3.0)

(3) Glasgow coma score (odds ratio -0.913 per unit)

(4) ISS (odds ratio 1.11 per unit)



The risk of mortality increases from >= 65 years of age with further increase if >= 80 years of age.

A Glasgow coma score <= 8 was seen in 10% of survivors vs 35% of non-survivors.

The ISS for survivors was 8 to 26 (mean 17) vs 13 to 39 (mean 27) for non-survivors


Flail chest and pulmonary contusion were not significant for predicting mortality in the multivariate analysis. The number of patients for whom the volume of the pulmonary contusion was measured was too small to reach a conclusion.


Other factors associated with prognosis:

(1) ARDS was seen in 36% of non-survivors vs 7% of survivors.

(2) ICU admission was seen in 97% of non-survivors vs 72% of survivors (not being admitted to the ICU associated with being a survivor).

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