Patients With Rib Fractures Do Not Develop Delayed Pneumonia: A Prospective, Multicenter Cohort Study of Minor Thoracic Injury - 24/11/12
, Marcel Émond, MD, MSc b, Miville Plourde, MD c, Chantal Guimont, MD, PhD d, Natalie Le Sage, MD, MSc b, Laurent Vanier, MD, PhD e, Eric Bergeron, MD f, Marilyne Dufresne, RN, BSc b, Nadine Allain-Boulé, MSc b, Ramona Fratu, BSc b
Address for correspondence: Jean-Marc Chauny, MD, MScRésumé |
Study objective |
Patients admitted to emergency departments (EDs) for minor thoracic injuries are possibly at risk of delayed pneumonia. We aimed to evaluate the incidence of delayed pneumonia post–minor thoracic injury and the associated risk factors.
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.
Conclusion |
This prospective cohort study of nonhospitalized patients with minor thoracic injuries revealed a low incidence of delayed pneumonia. Nonetheless, our results support tailored follow-up for asthmatic or chronic obstructive pulmonary disease patients with rib fracture.
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| Supervising editor: Judd E. Hollander, MD |
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| Author contributions: J-MC and ME were responsible for identifying the purpose of the project. J-MC, ME, and NLS were responsible for designing the study. J-MC, ME, CG, NLS, LV, and EB were responsible for acquisition of the data. J-MC was responsible for performing all database analysis and creating the tables. ME was responsible for administrative and technical support, obtaining funding, and creating the data. MD contributed to supervising recruitment and writing and revising the manuscript. N A-B contributed to study supervision, writing and revising the manuscript. RF had statistical expertise and contributed to performing all database analyses and creating the tables. J-MC takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This work was supported by a grant from Fonds de la Recherche en Santé du Québec (FRSQ 14056). |
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| Publication date: Available online April 27, 2012. |
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| Please see page 727 for the Editor's Capsule Summary of this article. |
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Vol 60 - N° 6
P. 726-731 - décembre 2012 Retour au numéro
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