LAUSR

BACKGROUND Traumatic flail chest results in respiratory distress and prolonged hospital stay. Timely surgical fixation of the flail chest reduces respiratory complications, decreases ventilator dependence, and shortens hospital stay. Concomitant head injury is not unusual in these patients and can postpone surgical timing due to the need to monitor the status of intracranial injuries. Reducing pulmonary sequelae also assists in the recovery from traumatic brain injury and improves outcomes. No previous evidence supports that early rib fixation can improve the outcome of patients with concomitant flail chest and traumatic brain injury. RESEARCH QUESTION Can early rib fixation improve the outcome of patients with concomitant flail chest and traumatic brain injury? STUDY DESIGN AND METHODS Adult patients with blunt injuries from the Trauma Quality Improvement Project between 2017 and 2019 were eligible for inclusion. Patients were divided into two treatment groups: operative and non-operative. Inverse probability treatment weighting was used to identify the predictors of mortality and adverse hospital events. RESULTS Patients in the operative group had a higher intubation rate (odd ratio [OR], 2.336; 95% confidence interval [CI], 1.644-3.318;P<0.001), longer length of stay (coefficient β, 4.664; standard error, 0.789;P<0.001), longer ventilator days (coefficient β, 2.020; standard error, 0.528;P<0.001), and lower mortality rate (OR], 0.247; 95% CI, 0.135-0.454;P<0.001). INTERPRETATION Timely rib fixation can improve the mortality rate of patients with flail chest with concomitant mild-to-moderate head injury.