In patients with not immediately life-threatening blunt chest wall trauma, it can be difficult to decide which patients may require hospitalization and which patients can safely return home.
A systematic review assessing risk factors for mortality in blunt chest wall trauma patients defined blunt chest wall trauma as “blunt chest injury resulting in chest wall contusion or rib fractures, with or without non-immediate life threatening injury” and excluded patients with: penetrating trauma, multi-trauma without chest trauma, or intra-thoracic injuries without chest wall trauma.
An increase in mortality was seen in:
- Patients aged 65 yrs or more (combined OR 1.98)
- Presence of 3 or more rib fractures (combined OR 2.02)
- Pre-existing condition, especially CHF (combined OR 2.43*)
- Development of pneumonia (combined OR 5.24*)
Although no validated guidelines yet exist to help risk stratify patients with mild to moderate blunt chest wall trauma, these factors may help identify patients at higher risk for developing delayed respiratory complications and failure.
*OR calculated based on limited number of studies
Battle CR, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: A systematic review and meta-analysis. Injury 2012;43:8-17.