Boserup Brad, Sutherland Mason, Paloka Rinald, McKenney Mark, Elkbuli Adel
Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.
Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida.
J Surg Res. 2022 Feb;270:376-385. doi: 10.1016/j.jss.2021.06.067. Epub 2021 Nov 2.
Motor vehicle collisions (MVCs) are a leading cause of morbidity and mortality. However, there is limited evidence examining the effects seatbelt use has on MVC-related injuries and outcomes in patients with rib fractures. We aim to assess how seatbelt use affects associated injuries and outcomes in adult MVC patients with ≥2 rib fractures.
This retrospective study utilized the American College of Surgeons (ACS) Trauma Quality Programs (TQP) Participant Use File (PUF) Database. Drivers/passengers who sustained ≥2 rib fractures following an MVC and had an AIS ≤2 for extra-thoracic body regions were analyzed. Patients were then subdivided by presence of flail chest into two cohorts, which were subdivided according to injury severity score (ISS) and seatbelt use. Logistic and linear regression was used to assess the impact of seatbelt use on outcomes.
Among both low and intermediate ISS classifications, restrained patients in the non-flail chest cohort had decreased incidence of pneumothorax, pulmonary contusion, and liver injury (P < 0.001). After adjusting for confounders, restrained patients (versus unrestrained) had decreased odds of pneumothorax (aOR = 0.91, P = <0.001) and acute respiratory distress syndrome (aOR=0.65, P = 0.02), while having increased odds of splenic laceration (aOR = 1.18, P = 0.003) (intermediate ISS group). Compared to unrestrained patients, restrained non-flail chest patients had a significantly decreased hospital length of stay (LOS) and intensive care unit LOS (P < 0.05).
Seatbelt use may be protective against serious injuries in patients with ≥2 rib fractures, resulting in improved outcomes. Education programs should be developed to bolster seatbelt compliance.
机动车碰撞（MVC）是发病和死亡的主要原因。然而，关于安全带使用对肋骨骨折患者MVC相关损伤和预后影响的证据有限。我们旨在评估安全带使用如何影响≥2根肋骨骨折的成年MVC患者的相关损伤和预后。
这项回顾性研究使用了美国外科医师学会（ACS）创伤质量项目（TQP）参与者使用文件（PUF）数据库。分析了在MVC后发生≥2根肋骨骨折且胸外身体区域损伤严重度评分（AIS）≤2的驾驶员/乘客。然后根据连枷胸的存在将患者分为两个队列，并根据损伤严重度评分（ISS）和安全带使用情况进一步细分。使用逻辑回归和线性回归来评估安全带使用对预后的影响。
在低ISS和中ISS分类中，非连枷胸队列中使用安全带的患者气胸、肺挫伤和肝损伤的发生率均降低（P<0.001）。在对混杂因素进行调整后，使用安全带的患者（与未使用安全带的患者相比）气胸（调整后比值比[aOR]=0.91，P<0.001）和急性呼吸窘迫综合征（aOR=0.65，P=0.02）的发生几率降低，而脾撕裂伤的发生几率增加（aOR=1.18，P=0.003）（中ISS组）。与未使用安全带的患者相比，使用安全带的非连枷胸患者住院时间（LOS）和重症监护病房LOS显著缩短（P<0.05）。
使用安全带可能对≥2根肋骨骨折的患者预防严重损伤有保护作用，从而改善预后。应制定教育计划以提高安全带的佩戴率。
