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Rib Fractures Remain a Marker of Injury Severity in Pediatric Trauma Patients
Mary Arbuthnot, DO, Chinwendu Onwubiko MD, PhD, Lindsey Bendure, MD, David P. Mooney, MD, MPH. Boston Children's Hospital, Boston, MA, USA.

Ribs are more elastic in infants and children, and thus, are less likely to fracture despite significant force. We sought to determine whether the presence or number of rib fractures in pediatric trauma patients was an indicator for severity of injury.

Methods: All children ≤ 18 years of age with ICD- 9th Revision diagnoses codes for rib fracture (807.XX) were extracted from our trauma registry at a Level I Pediatric Trauma Center. Outcome measures included intensive care unit (ICU) and hospital length of stay (LOS), and mortality.

Results: 94 (1.7%) of 5,686 trauma patients were admitted with ≥1 rib fracture. Mean age was 6.9 years and 64.9% were male. Average injury severity score was 16.9. Median number of rib fractures was 3 (range 1-21). The most common mechanisms of injury were non-accidental trauma (NAT) (n=40, 43.6%), pedestrian vs. car (n=10, 10.6%), and falls (n=10, 10.6%). Forty-three percent (n=43) patients had internal chest injuries (pulmonary contusion, pneumothorax, or hemothorax), and 44.7% (n=42) suffered multisystem injuries. Mortality rate was 2.1% (n=2). There was no correlation between number of rib fractures and age (rho=-0.3), ISS (rho=0.2), ICU LOS (rho=0.2), or hospital LOS (rho=0.4).

Conclusion: Traditionally, rib fractures are associated with a high morbidity. Although the overall mortality rate is low, the presence of ribs fractures in children is an indicator of severe injury. The number of ribs fractures does not appear to be related to severity of injury. Clinicians should have a high clinical suspicion of NAT in this setting.

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