Predictors of mortality in patients with rib fractures.

BACKGROUND: The aim of this study was to identify risk factors for morbidity and mortality in patients with rib fractures with focus on identifying a more exact age-dependent cut-off for increased morbidity and mortality. METHODS: Retrospective study of patients 16 years or older with rib fractures from blunt trauma. EXCLUSION CRITERIA: patients undergoing rib plating. Initial chest X-ray and Computed Tomography (CT) scans were re-read for the number of rib fractures (NRF) and presence of pulmonary contusion (PC). Data included demographics, mechanism of injury (MOI), NRF, associated injuries, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Geriatric Trauma Outcome Score (GTOS), presence of pneumothorax, hemothorax, hemo-pneumothorax, PC, Adult Respiratory Distress Syndrome (ARDS), pulmonary complications (ventilator-associated pneumonia, nosocomial pneumonia), and mortality. PC was quantified from CT scans with Mimics. Continuous data were analyzed using Student's t test. Variables significantly different by univariate analysis were analyzed by logistic regression analysis. RESULTS: The study group consisted of 1188 adult trauma patients admitted during a 2-year period; 800 males and 388 females, with a mean age of 54 ± 21. MOI: MVC, 735 (61.8%); falls, 364 (30.6%); other: 89. Mean NRF, 4 ± 2; GCS, GTOS, and ISS, 15 (15-15), 101 (82-124), and 19 ± 9, respectively. Incidence of PC was 329 (27.7%); PTX, HTX, and HTX/PTX, 264 (20.2%), 57 (4.8%), and 147 (12.4%). Flail chest, in 17 (1.4%); 321 required mechanical ventilation. Age, GCS, male gender, and ISS but not NRF and/or PC were predictive of mortality. CONCLUSIONS: Increased mortality in patients with rib fractures starts at 65 years of age without a further increase until age ≥ 80. NRF does not predict increased mortality independent of age. Severe TBI is the most common cause of death in patients 16-75 years, as opposed to respiratory complications in patients 80 years-old or greater.

The effect of robotic telerounding in the surgical intensive care units impact on medical education.

Robotic telerounding is effective from the standpoint of patients' satisfaction and patients' care in teaching and community hospitals. However, the impact of robotic telerounding by the intensivist rounding remotely in the surgical intensive care unit (SICU), on patients' outcome and on the education of medical students physician assistants and surgical residents, as well as on nurses' satisfaction has not been studied. Prospective evaluation of robotic telerounding (RT) using a Likert Scale measuring tool to assess whether it can replace conventional rounding (CR) from the standpoint of patients' care and outcome, nursing satisfaction, and educational effectiveness. RT did not have a negative impact on patients' outcome during the study interval: mortality 5/42 (12 %) versus 6/37 (16 %), RT versus CR, respectively, p = 0.747. The intensivists rounding in the SICU were satisfied with their ability to deliver the same patients' care remotely (Likert score 4.4 ± 0.2). The educational experience of medical students, physicia assistants, and surgical residents was not affected by RT (average Likert score 4.5 ± 0.2, 3.9 ± 0.4, and 4.4 ± 0.4 for surgical residents, medical students and PAs, respectively, p > 0.05). However, as shown by a Likert score of 3.5 ± 1.0, RT did not meet nurses' expectations from several standpoints. Intensivists regard robotic telerounding as an effective alternative to conventional rounding from the standpoint of patients' care and teaching. Medical students, physician assistants (PA's), and surgical residents do not believe that RT compromises their education. Despite similar patients' outcome, nurses have a less favorable opinion of RT; they believe that the physical presence of the intensivist is favorable at all times.