Department of Surgery, Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA.
Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, MetroHealth Medical Center, Cleveland, OH 44109, USA.
Medicina (Kaunas). 2023 Nov 20;59(11):2046. doi: 10.3390/medicina59112046.
: Protective equipment, including seatbelts and airbags, have dramatically reduced the morbidity and mortality rates associated with motor vehicle collisions (MVCs). While generally associated with a reduced rate of injury, the effect of motor vehicle protective equipment on patterns of chest wall trauma is unknown. We hypothesized that protective equipment would affect the rate of flail chest after an MVC. : This study was a retrospective analysis of the 2019 iteration of the American College of Surgeons Trauma Quality Program (ACS-TQIP) database. Rib fracture types were categorized as non-flail chest rib fractures and flail chest using ICD-10 diagnosis coding. The primary outcome was the occurrence of flail chests after motor vehicle collisions. The protective equipment evaluated were seatbelts and airbags. We performed bivariate and multivariate logistic regression to determine the association of flail chest with the utilization of vehicle protective equipment. : We identified 25,101 patients with rib fractures after motor vehicle collisions. In bivariate analysis, the severity of the rib fractures was associated with seatbelt type, airbag status, smoking history, and history of cerebrovascular accident (CVA). In multivariate analysis, seatbelt use and airbag deployment (OR 0.76 CI 0.65-0.89) were independently associated with a decreased rate of flail chest. In an interaction analysis, flail chest was only reduced when a lap belt was used in combination with the deployed airbag (OR 0.59 CI 0.43-0.80) when a shoulder belt was used without airbag deployment (0.69 CI 0.49-0.97), or when a shoulder belt was used with airbag deployment (0.57 CI 0.46-0.70). : Although motor vehicle protective equipment is associated with a decreased rate of flail chest after a motor vehicle collision, the benefit is only observed when lap belts and airbags are used simultaneously or when a shoulder belt is used. These data highlight the importance of occupant seatbelt compliance and suggest the effect of motor vehicle restraint systems in reducing severe chest wall injuries.
: 保护设备，包括安全带和安全气囊，极大地降低了与机动车碰撞（MVC）相关的发病率和死亡率。虽然通常与受伤率降低有关，但机动车保护设备对胸壁创伤模式的影响尚不清楚。我们假设保护设备会影响 MVC 后连枷胸的发生率。 : 这项研究是对美国外科医师学院创伤质量计划（ACS-TQIP）数据库 2019 年迭代的回顾性分析。肋骨骨折类型使用 ICD-10 诊断编码分为非连枷胸肋骨骨折和连枷胸。主要结果是机动车碰撞后发生连枷胸。评估的保护设备是安全带和安全气囊。我们进行了双变量和多变量逻辑回归，以确定连枷胸与车辆保护设备使用之间的关联。 : 我们确定了 25101 例机动车碰撞后肋骨骨折患者。在双变量分析中，肋骨骨折的严重程度与安全带类型、安全气囊状态、吸烟史和脑血管意外（CVA）史有关。在多变量分析中，安全带使用和安全气囊展开（OR 0.76，CI 0.65-0.89）与连枷胸发生率降低独立相关。在交互分析中，仅当使用安全带与展开的安全气囊结合使用时（OR 0.59，CI 0.43-0.80），或当不使用安全气囊展开安全带时（OR 0.69，CI 0.49-0.97），或当使用安全带与安全气囊展开时（OR 0.57，CI 0.46-0.70），连枷胸才会减少。 : 尽管机动车保护设备与机动车碰撞后连枷胸发生率降低有关，但只有当安全带和安全气囊同时使用或使用肩带时才能观察到这种益处。这些数据强调了乘员安全带合规的重要性，并表明机动车约束系统在减少严重胸壁损伤方面的作用。
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