Table 3 Summary of Key Results
Reference/ Sample Size/ Country | Country of origin | Study Design | Duration of follow up | Data Analysis | Key outcomes measured | Summary of Key Results |
|---|---|---|---|---|---|---|
Claydon et al. (2017) (n = 14) | UK Single Centre | Qualitative interview study | Interviews between 4 and 9-months after injury | Interpretive Phenomenological Analysis | Exploration of the experience and challenges associated with recovering after BTI | Struggling with breathing and pain were identified as key symptoms Initially, participants reported ‘feeling scared they may not survive’. These symptoms progressively improved but feeling ‘out of puff’ often continued. Many felt life was on hold. ‘Healing was considered a natural process’ which people couldn’t control producing frustration while awaiting for healing. Many thought they would not completely recover and eventually accepted functional limitations. Many felt lucky to be alive. All participants reported ‘feeling lucky to be alive’ and was related to an alteration in outlook toward making the most out of life. |
Marasco et al. (2015) (n = 397) | Australia Single Centre | Prospective Observational study | 24-months | Univariate and Multivariate Analysis | Glasgow Outcome Scale SF-12 at 6,12,24 months VAS pain Score | Over the 2 year follow up major trauma patients with multiple rib fractures exhibited substantially reduced HRQoL when compared to the published Australian normative data at all time points. Return to work rates were poor with only 71% of those working prior to the injury returning to any work within the 2-year follow-up. |
Gordy et al. (2014) (n = 203) | USA Single Centre | Prospective Observational study | 6-months | Univariate and Multivariate Analysis | SF-36 Health survey McGill Pain Questionnaire Present Pain Intensity Scales | The incidence of chronic pain was 22% and disability was 53%. Acute PPI predicted Chronic pain. Associated injuries, bilateral rib fractures, injury severity score, and number of rib fractures were not predictive of chronic pain. No acute injury characteristics were predictive of disability. |
Marasco et al. (2013) (n = 46) | Australia Single Centre | Randomised Controlled Trial | 6-months | Univariate and Multivariate Analysis | SF-36 Health Survey at 6 months Spirometry Results at 3 months 3D CT results at 3 months | Participants receiving operative fixation had significantly shorter ICU length of stay and had reduced requirements for NIV post extubation. No differences in spirometry results at 3 months No difference in HRQoL at 6 months |
Daoust et al. (2013) (n = 734) | Canada Multi-centre | Prospective Observational Study | Follow-up at 1-month and 3-months | Univariate/Multivariate analysis and trajectory modelling | Pain Score (Range: 0–10) | 18.2% of participants reported experiencing substantial pain at 90 days after injury and identified a pain trajectory with similar characteristics. Multivariate modelling identified 2 or more rib fractures, smoking and initial oxygen saturations less than 95% to be predictors of on-going pain at 90 days after injury |
Bille et al. (2013) (n = 10) | UK Single Centre | Prospective observational study | Mean follow up 14 months (range: 8–23.5) | Univariate Analysis | Pain Visual Analogue Scale (VAS) QoL EORTC QLQ-C30 | Seven patients scored the pain as 0, one as 1 (mild), one as 4 (moderate) and one as 8 (severe). Only two patients where using PRN analgesics. Only one patient presents severe limitation in his daily life, scoring his QOL as poor. |
Fabricant et al. (2013) (n = 203) | USA Single Centre | Prospective observational study | 2-month | Univariate and Multivariate Analysis | McGill Pain Questionnaire: Pain Rating Index (PRI) and Present Pain Intensity (PPI) scale | 59% (n = 110) patients had prolonged chest wall pain and 76% (n = 142) had prolonged disability. In patients with isolated rib fractures, n = 67 (64%) had prolonged chest wall pain and n = 69 (66%) had prolonged disability. MPQ PPI was predictive of prolonged pain (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4 to 2.5), and prolonged disability (OR, 2.2; 95% CI, 1.5 to 3.4). A significant associated injury was predictive of prolonged disability (OR, 5.9; 95% CI, 1.4 to 29). |
Shelat et al. (2012) (n = 102) | Singapore Single Centre | Prospective observational study | Single episode of follow-up 1 year after injury | Univariate Analysis | Unvalidated assessment of quality of life | 22.5% (n = 23) complained of chronic pain. Of these, 26% (n = 6) regularly used analgesic agents, 35% (n = 8) complained of impaired work life and 13% (n = 3) complained of impaired personal QoL. Chronic pain was not related to age, number of rib fractures, flail chest, haemothorax and/or pneumothorax, chest tube insertion or Injury Severity Score (ISS). |
Amital et al. (2009) (n = 13) | Israel Single Centre | Prospective observational study | Single episode of follow-up | Univariate Analysis | Lung function Tests | Lung function test results: Mean forced expiratory volume in the first second was 85 (±13), residual volume was 143 ± 33.4%, and total lung capacity was 87 (±24). Post exercise oxygen saturation was normal in all patients (97 ± 1.5), and mean oxygen consumption max/kg was 18 ± 4.3 ml/kg/min (60.2 ± 15). |
Mayberry et al. (2009) (n = 15) | USA Single Centre | Prospective observational study | Single episode of follow-up between 19-months and 8-years after injury | Univariate Analysis | SF-36 Physical Component score Employment Functional Status Overall health perception Pre-injury activity levels Co-morbidity Complications | Mean long-term MPQ Pain Rating Index was 6.7 (±2.1). SF-36 identified equivalent or better health status compared with references except for role limitations due to physical problems when compared with the general population. The operative fixation of BTI is associated with low long-term morbidity and pain, as well as HRQoL closely equivalent to the general population. |
Leone et al. (2008) (n = 55) | France Single Centre | Prospective observational study | Follow up at 6-months and 1 year after injury | Univariate and Multivariate Analysis | Lung Function Tests Karnofsky Performance Status New York Heart Associated Classification St George Respiratory Questionnaire | 71% (n = 39) had abnormal Lung Function Physical function was decreased in 70% (n = 38) 72% (n = 29) had a reduced 6-min walk distance Abnormal imaging was identified in 60% (n = 33) but this did not relate to lung function tests A ratio of arterial oxygen pressure to inspired oxygen fraction less than 200 at admission to ICU predicted abnormal lung function tests at 6 months. |
Kerr-Valentic et al. (2003) (n = 40) | USA Single Centre | Prospective Observational study | 4-months | Univariate and Multivariate Analysis | VAS pain score at 1,5,30,120 days post injury Short Form – 36 (30 days post injury) Total days out of work (120 days post injury) | Mean thoracic pain was 3.5 (±2.1) at 30 days and 1.0 (±1.4) at 120 days. When compared to the normative data, participants had higher disability at 30 days (p < 0.001) in all data sets excluding ‘emotional stability’, which indicated equivalent disability, and the perception of general health, where they were significantly less disabled (p < 0.001). The total mean days away from work/usual activity was 70 (±41). Days away from work were significantly lower in isolated BTI compared to those with extra-thoracic injury 51 (±39) vs. 91 (±33), p < 0.01 |
Mouton et al. (1997) (n = 23) | Switzerland Single Centre | Prospective Observational study | Single assessment, mean follow-up time 28 months | Univariate Analysis | Chest wall and shoulder girdle function Working capacity Sports activity Pain Chest wall deformity Morbidity | 95% reported a 100% working capacity at assessment. 86% reported returning to pre-injury sporting activates without chest or shoulder girdle pain or dysfunction. |
Beal & Oreskovich (1985) (n = 20) | USA Single Centre | Prospective observational study | Single assessment between 50 and 732-days post injury | Nil statistical analysis reported | Chest wall pain Chest wall deformity Exertional dyspnoea Employment status General Health Complications. | 63.6% (n = 14) reported long term morbidity. Most common long-term problem = chest wall pain Pain prevented return to work in n = 3 participants |
Landercasper et al. (1984) (n = 62) | USA Single Centre | Prospective observational study | Single assessment between 6 months and 12-years post injury | Nil statistical analysis reported | Dyspnoea Chest pain/tightness Employment history Lifestyle changes Chest x-ray Spirometry changes | 38% (n = 12) had returned to full-time employment at point of follow-up 25% (n = 8) had subjective chest tightness 48% (n = 15) complained of chest wall pain 38% (n = 12) reported moderate to severe change in their overall level of activity. |