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Original Articles: General Thoracic

Risk Factors for 24-Hour Mortality After Traumatic Rib Fractures Owing to Motor Vehicle Accidents: A Nationwide Population-Based Study

^a Division of Thoracic Surgery, Department of Surgery, Taipei Medical University and Hospital, Taipei, Taiwan
^b Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
^c Mackay Medicine, Nursing, and Management College, Taipei, Taiwan
^d School of Health Care Administration, Taipei Medical University, Taipei, Taiwan

Accepted for publication June 1, 2009.

^_* Address correspondence to Dr Lin, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan (Email: henry11111{at}tmu.edu.tw).

Background: Accurate identification of patients at high risk of death as a result of major chest trauma is essential within a trauma system. We used 3-year population-based data in Taiwan to evaluate risk factors associated with 24-hour mortality among adults with obvious rib fractures and needing hospitalization after traffic accidents.

Methods: Pooled data from Taiwan's National Health Insurance Research Database for the years 2002 through 2004 were used. A total of 18,856 patients hospitalized with rib fractures after traffic accidents were included. Multivariate logistic regression using generalized estimating equations was performed to explore the relationship between 24-hour mortality and patients' age, sex, and comorbid conditions, as well as hospital characteristics, adjusting for social factors and any clustering of the sampled patients by hospital.

Results: Of patients in the sample, 459 (2.4%) died within 24 hours of admission. Patients who had six or more rib fractures were three times more likely to die within 24 hours of admission compared with patients with only one rib fracture (odds ratio [OR], 3.16; p < 0.001). The adjusted odds of death within 24 hours were higher for patients who had hemopneumothorax (OR, 3.15; p < 0.001), extremity fractures (OR, 1.74; p < 0.001), pelvic fractures (OR, 2.92; p < 0.001), head injuries (OR, 4.29; p < 0.001), spleen injury (OR, 1.83; p < 0.05), hepatic injury (OR, 4.39; p < 0.001), heart injury (OR, 4.48; p < 0.001), and diaphragm injury (OR, 3.16; p < 0.05) compared with patients who had none of these injuries.

Conclusions: We concluded that more than six ribs fractured, heart injuries, hepatic injuries, head injuries, and advanced age are the most important determinants of 24-hour mortality after thoracic trauma from traffic accidents.