What is the mortality rate for rib fractures?

Updated: Jun 13, 2017
  • Author: Sarah L Melendez, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Rib fractures are not usually dangerous in and of themselves. Patients may develop pneumonia from splinting. Morbidity correlates with the degree of injury to underlying structures.

In one study of patients with rib fractures, the mortality rate reached 12%; of these, 94% had associated injuries and 32% had a hemothorax or a pneumothorax. [19] More than half of all patients required either operative or ICU management. Average blood loss per fractured rib is reportedly 100-150 mL.

In one retrospective study of 99 elderly patients, 16% of patients (95% confidence interval [CI], 9.5-24.9%) developed adverse events, including 2 deaths. [20] Adverse events were defined as acute respiratory distress syndrome (ARDS), pneumonia, unanticipated intubation, transfer to ICU for hypoxemia, or death. Risk factors associated with these adverse events were age ≥85 years, initial systolic blood pressure < 90 mm Hg, hemothorax, pneumothorax, 3 or more unilateral rib fractures, or pulmonary contusion. These risk factors predicted adverse events with 100% sensitivity (95% CI, 79.4-100%), and 38.6% specificity (95% CI, 28.1-49.9%), and they may identify variables that might aid in identifying patients at high risk for serious adverse events if validated in a larger prospective study.

A study of rib fractures in patients younger than 21 years found that mortality increased nearly linearly for increasing numbers of pediatric rib fractures. Odds of mortality increased with each additional rib fractured in all pediatric age groups. Mortality doubled from 1.79% without rib fracture to 5.81% for 1 rib fracture and then nearly linearly increased to 8.23% for 7 fractures. Ventilator days also increased with increasing number of rib fractures. [21]

Rib fractures are the most common injury in elderly blunt chest trauma patients, and each additional rib fracture increases the odds of dying by 19% and of developing pneumonia by 27%. [22, 23]

Position of the fractured rib in the thorax helps identify potential injury to specific underlying organs. Fracture of the lower ribs usually is associated with injury to abdominal organs rather than to lung parenchyma. Fracture of the left lower ribs is associated with splenic injuries, and fracture of the right lower ribs is associated with liver injuries. Fracture of the floating ribs (ribs 11, 12) is often associated with renal injuries.

First rib fractures have often been described as having a high association with serious or lethal spinal or vascular injuries. [24, 3] They are rarest of all rib fractures [9] and were once thought to be a harbinger of severe trauma, [25] since the first rib is very well protected by the shoulder, lower neck musculature, and clavicle.

First rib fractures were thought to require a much higher impact force to fracture than other ribs, but that theory is now in question. Until further studies are done, fractures of the first rib should raise suspicion of significant chest trauma. The presence of a first rib injury requires a multidisciplinary approach. CT of the spine and chest allows for an early diagnosis. Appropriate treatment and observation in the intensive care unit may prevent further morbidity and/or mortality. [24]

While first rib fractures have a high association with spinal fractures and are associated with multisystem injuries, the occurrence of first rib fractures is not always associated with increased morbidity and mortality. [24] Mortality rates as high as 36% have been previously reported with fractures of the first rib, which are associated with injury to the lung, ascending aorta, subclavian artery, and brachial plexus. [5] Other complications associated with first rib fractures include delayed subclavian vessel thrombosis, aortic aneurysm, tracheobronchial fistula, thoracic outlet syndrome, [26] , and Horner syndrome. [27]

The association of lower rib fractures with pelvic fractures has been associated with a higher incidence of solid organ injury. [28]

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