Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study
Objectives Isolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pn...
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BMJ Publishing Group
2017-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/7/1/e013029.full |
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| author | Yu-Hsun Wang Ming-Chih Chou Sai-Wai Ho Ying-Hock Teng Shun-Fa Yang Han-Wei Yeh Chao-Bin Yeh |
| author_facet | Yu-Hsun Wang Ming-Chih Chou Sai-Wai Ho Ying-Hock Teng Shun-Fa Yang Han-Wei Yeh Chao-Bin Yeh |
| author_sort | Yu-Hsun Wang |
| collection | DOAJ |
| description | Objectives Isolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas.Design Nationwide population-based cohort study.Setting Patients with IMRFs were identified between 2010 and 2011 from the Taiwan National Health Insurance Research Database.Participants Non-traumatic patients were matched through 1:8 propensity-score matching according to age, sex, and comorbidities (namely diabetes, hypertension, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD)) with the comparison cohort. We estimated the adjusted HRs (aHRs) by using the Cox proportional hazard model. A total of 709 patients with IMRFs and 5672 non-traumatic patients were included.Main outcome measure The primary end point was the occurrence of pneumonia within 30 days.Results The incidence of pneumonia following IMRFs was 1.6% (11/709). The aHR for the risk of pneumonia after IMRFs was 8.94 (95% CI=3.79 to 21.09, p<0.001). Furthermore, old age (≥65 years; aHR=5.60, 95% CI 1.97 to 15.89, p<0.001) and COPD (aHR=5.41, 95% CI 1.02 to 3.59, p<0.001) were risk factors for pneumonia following IMRFs. In the IMRF group, presence of single or two isolated rib fractures was associated with an increased risk of pneumonia with aHRs of 3.97 (95% CI 1.09 to 14.44, p<0.001) and 17.13 (95% CI 6.66 to 44.04, p<0.001), respectively.Conclusions Although the incidence of pneumonia following IMRFs is low, patients with two isolated rib fractures were particularly susceptible to pneumonia. Physicians should focus on this complication, particularly in elderly patients and those with COPD. |
| format | Article |
| id | doaj-art-d8fcb09ec65d4cac809741db3d278457 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d8fcb09ec65d4cac809741db3d2784572025-02-03T22:30:13ZengBMJ Publishing GroupBMJ Open2044-60552017-01-017110.1136/bmjopen-2016-013029Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort studyYu-Hsun Wang0Ming-Chih Chou1Sai-Wai Ho2Ying-Hock Teng3Shun-Fa Yang4Han-Wei Yeh5Chao-Bin Yeh64Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan1Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan1Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan2Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan1Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan5School of Medicine, Chang Gung University, Taoyuan City, Taiwan2Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, TaiwanObjectives Isolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas.Design Nationwide population-based cohort study.Setting Patients with IMRFs were identified between 2010 and 2011 from the Taiwan National Health Insurance Research Database.Participants Non-traumatic patients were matched through 1:8 propensity-score matching according to age, sex, and comorbidities (namely diabetes, hypertension, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD)) with the comparison cohort. We estimated the adjusted HRs (aHRs) by using the Cox proportional hazard model. A total of 709 patients with IMRFs and 5672 non-traumatic patients were included.Main outcome measure The primary end point was the occurrence of pneumonia within 30 days.Results The incidence of pneumonia following IMRFs was 1.6% (11/709). The aHR for the risk of pneumonia after IMRFs was 8.94 (95% CI=3.79 to 21.09, p<0.001). Furthermore, old age (≥65 years; aHR=5.60, 95% CI 1.97 to 15.89, p<0.001) and COPD (aHR=5.41, 95% CI 1.02 to 3.59, p<0.001) were risk factors for pneumonia following IMRFs. In the IMRF group, presence of single or two isolated rib fractures was associated with an increased risk of pneumonia with aHRs of 3.97 (95% CI 1.09 to 14.44, p<0.001) and 17.13 (95% CI 6.66 to 44.04, p<0.001), respectively.Conclusions Although the incidence of pneumonia following IMRFs is low, patients with two isolated rib fractures were particularly susceptible to pneumonia. Physicians should focus on this complication, particularly in elderly patients and those with COPD.https://bmjopen.bmj.com/content/7/1/e013029.full |
| spellingShingle | Yu-Hsun Wang Ming-Chih Chou Sai-Wai Ho Ying-Hock Teng Shun-Fa Yang Han-Wei Yeh Chao-Bin Yeh Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study BMJ Open |
| title | Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study |
| title_full | Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study |
| title_fullStr | Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study |
| title_full_unstemmed | Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study |
| title_short | Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study |
| title_sort | risk of pneumonia in patients with isolated minor rib fractures a nationwide cohort study |
| url | https://bmjopen.bmj.com/content/7/1/e013029.full |
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