Garcia V F, Gotschall C S, Eichelberger M R, Bowman L M
Department of Surgery, George Washington University Medical Center, Washington, D.C.
J Trauma. 1990 Jun;30(6):695-700.
The early recognition of life-threatening injury is paramount to the prompt initiation of appropriate care. This study assesses the importance of multiple rib fractures as a marker of severe injury in children. We analyzed physiologic, etiologic, and injury data for 2,080 children with blunt or penetrating trauma aged 0-14 years consecutively admitted to a Level I pediatric trauma center. Analysis of variance, Student's t-test, and the Chi-square test of independence were used to test for differences between children with rib fractures and other children. Probability of survival was modeled using stepwise logistic regression. There were 14 deaths among 33 children with rib fractures, a mortality rate of 42%. Child abuse accounted for 63% of the injuries to children less than 3 years old, while pedestrian injuries predominated among older children. Children with rib fractures were significantly more severely injured than children with blunt or penetrating trauma but without rib fractures. When compared to children without rib fractures, children with rib fractures had a higher mortality rate, but no statistically significant difference in morbidity. The mortality rate for the 18 children with both rib fractures and head injury was 71%. A logistic model with variables measuring severity of head injury and number of ribs fractured correctly predicted survival in more than 85% of children with thoracic trauma. Although rib fractures are rare injuries in childhood, they are associated with a high risk of death. The risk of mortality increases with the number of ribs fractured. The combination of rib fractures and head injury was usually fatal.
早期识别危及生命的损伤对于及时开展恰当治疗至关重要。本研究评估了多发性肋骨骨折作为儿童严重损伤标志物的重要性。我们分析了连续入住一级儿科创伤中心的2080名0至14岁钝性或穿透性创伤儿童的生理、病因和损伤数据。采用方差分析、学生t检验和卡方独立性检验来检测肋骨骨折儿童与其他儿童之间的差异。使用逐步逻辑回归对生存概率进行建模。33名肋骨骨折儿童中有14例死亡，死亡率为42%。虐待儿童占3岁以下儿童受伤原因的63%，而年长儿童中行人受伤占主导。肋骨骨折儿童比钝性或穿透性创伤但无肋骨骨折的儿童受伤严重得多。与无肋骨骨折儿童相比，肋骨骨折儿童死亡率更高，但发病率无统计学显著差异。18名同时有肋骨骨折和头部损伤的儿童死亡率为71%。一个包含测量头部损伤严重程度和肋骨骨折数量变量的逻辑模型能正确预测超过85%的胸部创伤儿童的生存情况。虽然肋骨骨折在儿童期是罕见损伤，但它们与高死亡风险相关。死亡率风险随肋骨骨折数量增加而上升。肋骨骨折与头部损伤同时出现通常是致命的。
