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J Chest Surg

Published online April 11, 2024

Copyright © Journal of Chest Surgery.

Routine 6-Week Outpatient Radiography and Visit in Patients with Conservatively Treated Multiple Rib Fractures: Valuable or a Waste of Resources?

Felix Peuker , B.Sc.1,2,3, Thomas Philip Bosch , B.Sc.2,4, Roderick Marijn Houwert , M.D., Ph.D.1, Ruben Joost Hoepelman , M.D.1, Menco Johannes Sophius Niemeyer , M.D.1, Mark van Baal , M.D., Ph.D.1, Fabrizio Minervini , M.D., Ph.D.5, Frank Johannes Paulus Beeres , M.D., Ph.D.2,3, Bryan Joost Marinus van de Wall , M.D., Ph.D., M.Sc.2,3

1Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; 2Department of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne; 3Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; 4Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands; 5Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland

Correspondence to:Felix Peuker
Tel 31-647597078
Fax 31-088-75-555-04
E-mail felix@peuker.nl
ORCID
https://orcid.org/0009-0006-5654-5028

Received: September 25, 2023; Revised: January 26, 2024; Accepted: February 5, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: This study investigated the incidence and clinical consequences of abnormal radiological and clinical findings during routinely performed 6-week outpatient visits in patients treated conservatively for multiple (3 or more) rib fractures.
Methods: A retrospective analysis was conducted among patients with multiple rib fractures treated conservatively between 2018 and 2021 (Opvent database). The primary outcome was the incidence of abnormalities on chest X-ray (CXR) and their clinical consequences, which were categorized as requiring intervention or additional clinical/radiological examination. The secondary focus was the incidence of deviation from standard treatment in response to the findings (clinical or radiological) at the routine 6-week outpatient visit.
Results: In total, 364 patients were included, of whom 246 had a 6-week visit with CXR. The median age was 57 years (interquartile range, 46–70 years) and the median Injury Severity Score was 17 (interquartile range, 13–22). Forty-six abnormalities (18.7%) were found on CXR. These abnormalities resulted in additional outpatient visits in 4 patients (1.5%) and in chest drain insertion in 2 (0.8%). Only 2 patients (0.8%) with an abnormality on CXR presented without symptoms. None of the 118 patients who had visits without CXR experienced problems.
Conclusion: Routine 6-week outpatient visits for patients with conservatively treated multiple rib fractures infrequently revealed abnormalities requiring treatment modifications. It may be questioned whether the 6-week outpatient visit is even necessary. Instead, a more targeted approach could be adopted, providing follow-up to high-risk or high-demand patients only, or offering guidance on recognizing warning signs and providing aftercare through a smartphone application.

Keywords: Multiple rib fractures, Conservative treatment, Follow-up, Radiography

Article

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J Chest Surg

Published online April 11, 2024

Copyright © Journal of Chest Surgery.

Routine 6-Week Outpatient Radiography and Visit in Patients with Conservatively Treated Multiple Rib Fractures: Valuable or a Waste of Resources?

Felix Peuker , B.Sc.1,2,3, Thomas Philip Bosch , B.Sc.2,4, Roderick Marijn Houwert , M.D., Ph.D.1, Ruben Joost Hoepelman , M.D.1, Menco Johannes Sophius Niemeyer , M.D.1, Mark van Baal , M.D., Ph.D.1, Fabrizio Minervini , M.D., Ph.D.5, Frank Johannes Paulus Beeres , M.D., Ph.D.2,3, Bryan Joost Marinus van de Wall , M.D., Ph.D., M.Sc.2,3

1Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; 2Department of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne; 3Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; 4Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands; 5Department of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland

Correspondence to:Felix Peuker
Tel 31-647597078
Fax 31-088-75-555-04
E-mail felix@peuker.nl
ORCID
https://orcid.org/0009-0006-5654-5028

Received: September 25, 2023; Revised: January 26, 2024; Accepted: February 5, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: This study investigated the incidence and clinical consequences of abnormal radiological and clinical findings during routinely performed 6-week outpatient visits in patients treated conservatively for multiple (3 or more) rib fractures.
Methods: A retrospective analysis was conducted among patients with multiple rib fractures treated conservatively between 2018 and 2021 (Opvent database). The primary outcome was the incidence of abnormalities on chest X-ray (CXR) and their clinical consequences, which were categorized as requiring intervention or additional clinical/radiological examination. The secondary focus was the incidence of deviation from standard treatment in response to the findings (clinical or radiological) at the routine 6-week outpatient visit.
Results: In total, 364 patients were included, of whom 246 had a 6-week visit with CXR. The median age was 57 years (interquartile range, 46–70 years) and the median Injury Severity Score was 17 (interquartile range, 13–22). Forty-six abnormalities (18.7%) were found on CXR. These abnormalities resulted in additional outpatient visits in 4 patients (1.5%) and in chest drain insertion in 2 (0.8%). Only 2 patients (0.8%) with an abnormality on CXR presented without symptoms. None of the 118 patients who had visits without CXR experienced problems.
Conclusion: Routine 6-week outpatient visits for patients with conservatively treated multiple rib fractures infrequently revealed abnormalities requiring treatment modifications. It may be questioned whether the 6-week outpatient visit is even necessary. Instead, a more targeted approach could be adopted, providing follow-up to high-risk or high-demand patients only, or offering guidance on recognizing warning signs and providing aftercare through a smartphone application.

Keywords: Multiple rib fractures, Conservative treatment, Follow-up, Radiography

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