Patients With Rib Fractures Do Not Develop Delayed Pneumonia: A Prospective, Multicenter Cohort Study of Minor Thoracic Injury
Annals of Emergency Medicine,

Chauny JM et al. – This prospective cohort study of nonhospitalized patients with minor thoracic injuries revealed a low incidence of delayed pneumonia. Nonetheless, the results support tailored follow–up for asthmatic or chronic obstructive pulmonary disease patients with rib fracture.

Methods
  • A prospective, multicenter cohort study was conducted in 4 Canadian EDs, from November 2006 to November 2010.
  • All consecutive patients aged 16 years and older with minor thoracic injury who were discharged from the ED were screened for eligibility.
  • Uniform clinical and radiologic evaluations were performed on the initial ED visit and were repeated at weeks 1 and 2.
  • Relative risk analyses quantified incidence with comparison by age, sex, smoking status, alcohol intoxication, pulmonary comorbidity, ability to cough atelectasis, pain level, and number of rib fractures.

Results
  • Of the 1,057 participants recruited, 347 (32.8%) had at least 1 rib fracture, 87 (8.2%) had asthma, and 36 (3.4%) had chronic obstructive pulmonary disease.
  • Only 6 patients (0.6%; 95% confidence interval 0.24% to 1.17%) developed pneumonia during the follow-up period.
  • The relative risk for patients with preexistent pulmonary disease and radiologically proven rib fractures was 8.6 (P=.045; 95% confidence interval 1.05 to 70.9).
  • Sex, smoking habit, initial atelectasis, ability to cough, and alcohol intoxication were not significantly associated with delayed pneumonia.

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