Predictors of Pulmonary Complications After Rib Fractures: Systematic Review and Meta-Analyses.

In 30 seconds

This systematic review and meta-analysis examined multivariable-adjusted predictors of pulmonary complications in adults with blunt rib fractures. Twelve studies involving 72,380 patients from nine countries were included. Displaced rib fractures had the strongest pooled association with complications (adjusted OR 3.32, 95% CI 1.78-6.19; I² = 0%). Male sex was also associated (OR 2.02, 95% CI 1.17-3.48; I² = 0%). Greater fracture burden showed an exploratory association (OR 2.10, 95% CI 1.20-3.67), but varied thresholds and outcomes limit its interpretation as a single clinical effect.

Key findings

• Displaced rib fractures were associated with pulmonary complications: pooled adjusted OR 3.32, 95% CI 1.78-6.19; I² = 0%.
• Male sex was independently associated with complications (OR 2.02, 95% CI 1.17-3.48; I² = 0%).
• Fracture burden had an exploratory pooled association (OR 2.10, 95% CI 1.20-3.67; I² = 25%), with heterogeneous thresholds and outcomes.
• Narrative synthesis also identified age ≥65 y, chronic obstructive pulmonary disease, upper or midline fractures, and bilateral involvement as higher-risk features.

Why it matters

Pulmonary complications are a major source of morbidity, mortality, and resource use after rib fractures. Identifying features associated with higher risk may help clinicians structure early assessment and monitoring. The pooled estimates distinguish the comparatively consistent association with displacement from the more uncertain fracture-burden estimate, while the narrative findings add patient and injury characteristics for consideration.

What to keep in mind

The fracture-burden estimate combined heterogeneous thresholds and a delayed-outcome estimate, so it is exploratory. The review also notes that publication-bias tests are underpowered with few studies and calls for prospective studies using standardized outcomes and validated prediction models.