![]() ![]() The intervention, rib ORIF, was compared against nonoperative management, as described earlier. After rounding to the nearest integer, outcomes with an average score of 7 or greater (considered to be critical) were included in our PICO questions. Outcomes with scores 7 to 9 were considered critical, those with scores 4 to 6 were considered important, and those with scores in the 1 to 3 range were considered of limited importance. Numerous candidate outcomes (including in-hospital mortality DMV, ICU LOS, and hospital LOS incidence of pneumonia need for tracheostomy pain control lung volumes on spirometry quality of life after discharge exercise tolerance chronic disability and time away from work) were voted on independently by each author on a scale from 1 to 9 per the GRADE methodology. Classification of Important Outcomes in Patients With Rib Fractures After Blunt Trauma Undergoing Rib ORIF for PICO 1 (Rib ORIF in Trauma Patients With Flail Chest) and PICO 2 (Rib ORIF in Trauma Patient With Nonflail Rib Fractures) Any disagreement on inclusion was resolved by consensus (Fig. Titles and abstracts were screened, and full articles were reviewed as needed. Upon completion of the electronic literature search, citation lists were independently reviewed by two authors (G.K., M.B.P.) to identify potentially relevant studies. For a study to be included in our final analysis, a clear comparison between operative versus nonoperative subjects had to be present and at least one of the critical outcomes reported. The reference lists of retrieved papers were also screened to identify additional studies. Case reports, commentaries, and animal studies were excluded, as were studies describing operative technique alone, and reviews. Prospective trials and retrospective cohort/case-control studies that compared rib ORIF versus nonoperative management of rib fractures in adults with either flail and/or nonflail chest patients were eligible for inclusion and were retrieved. The ranges for our literature search were from January 1900 to January 2016. The following medical subject headings (MeSH) terms were included: rib fracture, flail chest, fracture treatment, surgical management, fixation, plating, ORIF in various combinations.1 No restrictions were placed on language. Subsequently,, Embase, and the Cochrane databases were searched in duplicate by professional librarians from two medical schools (Boston University and Harvard University) on January 29, 2016. Our systematic review was registered with the PROSPERO registry of systematic reviews and meta-analyses (Registration No. PRISMA flow diagram for study selection for analysis. * PICO Question 2: In adult patients with nonflail rib fractures after blunt trauma, should rib ORIF be performed (versus nonoperative management) to decrease mortality and incidence of pneumonia shorten DMV, hospital LOS improve pain control and decrease need for tracheostomy if applicable? Identification of Referencesįigure 1. * PICO Question 1: In adult patients with flail chest after blunt trauma, should rib ORIF be performed (versus nonoperative management) to decrease mortality DMV, ICU LOS, and hospital LOS incidence of pneumonia and need for tracheostomy and improve pain control? * Outcomes: mortality duration of mechanical ventilation (DMV) ICU and hospital length of stay (LOS) incidence of pneumonia need for tracheostomy and pain control. ![]() * Intervention: operative fixation of fractured ribs. * Population: adult patients (>18 years of age) with rib fractures following blunt trauma. Our population, intervention, comparator, and outcome (PICO) questions are defined as follows: MD, MPH Alarcon, Louis MD Bosarge, Patrick L. Kasotakis, George MD, MPH Hasenboehler, Erik A. Exempt Purpose, Mission, Vision & Goals.Interviews with Research Scholarship & Award Recipients.Equity, Diversity, and Inclusion in Trauma Surgery Practice.Landmark Papers in Trauma and Acute Care Surgery. ![]()
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