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Final Presentation- Caitlyn Ryan

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Final Presentation- Caitlyn Ryan

  1. 1. Caitlyn Ryan, Summer Research Intern Andrew R. Doben, M.D.
  2. 2.  Flail Chest and how it is treated  Background information on rib fractures  Surgical Rib Fixation (SRF) and how it is utilized at Baystate  Study methods and results/conclusions  Future of SRF?
  3. 3. • A flail chest occurs when a segment of the thoracic cage is separated from the rest of the chest wall. • Result of a crushing chest injury • Paradoxical respiration http://medical-dictionary.thefreedictionary.com/flail+segment This image shows the paradoxical movements of the flail segments
  4. 4.  Major source of morbidity in the U.S.  Significant advances in pain control, no improvement in the outcomes  Various reports beginning in the 1950s and sporadic attempts through the mid 80’s  The safety and efficiency of SRF remains uncertain (especially in age ≥ 65 population)
  5. 5.  11,807 Deaths from Thoracic Trauma  Mortality was 22% for the elderly versus 10% for the young  The most common complication of rib fractures is pneumonia  Up to 60% patients do not return to full time employment
  6. 6.  Surgical Rib Fixation is a surgery that allows surgeons to apply artificial support to fractured ribs  There are different methods of support that can be used during SRF; these include Rib Loc, Synthes Rib Matrix, and Intramedullary Nail  Here at Baystate, the Synthes Rib Matrix is utilized
  7. 7. Ribs are realigned and osteosynthes plates are bent/cut to fit specific ribs. The ribs are held together by the osteosynthes plate, which is screwed into the ribs. Important for restoration of the integrity of the chest wall: • Plate apposition • tissue mobilization • shape formation
  8. 8. Baystate Medical Center has created a multidisciplinary team approach to the care of rib fracture patients.  This includes specific pain regimens, multimodality target respiratory therapy, and surgical intervention  The study conducted here at Baystate focused on the concept of age restrictions within the SRF patient population
  9. 9.  Patients with flail chest or severe rib fractures who were admitted to a Level 1 Trauma Center for SRF between July 2010 and June 2014 were evaluated  Patients age ≥ 65 and age ≤ 64 were evaluated and compared in the outcome variables: 1. Injury Severity Score 2. Total number of Fractures 3. Hospital Length of Stay 4. ICU LOS 5. Ventilator Days 6. Fractures Repaired
  10. 10.  Utilized REDCap Database, which is a secure, web-based application for building and managing online databases  Research Electronic Data Capture  Also provides automated export procedures for easy statistical analysis
  11. 11. The median number of ventilator days, ISS, ICU LOS, and Hospital LOS were similar in both groups, signaling that there should not be age restrictions on surgical rib fixations.
  12. 12.  This project is intended to improve the care and outcomes of patients with rib fractures.  Presentation at EAST (Eastern Association for Aurgical Trauma) at end of January 2015  Creation of a national registry http://www.swedish.org/about/blog/august-2012/rib-fractures- essentials-of-management-treatment
  13. 13. Thank you to Andrew Doben, M.D., who is the primary researcher of this project Thank you to Jeffry Nahmias, M.D., who made this internship opportunity possible Thank you to Jane Sicard and the Summer Scholars for giving me the opportunity to present my research here today
  14. 14. 1. Flail chest. (n.d.). Medterms. Retrieved July 21, 2014, from http://www.medterms.com/script/main/art.asp?articlekey=3473 2. flail segment. (n.d.). TheFreeDictionary.com. Retrieved July 16, 2014, from http://medical- dictionary.thefreedictionary.com/flail+segment(flail segment image/definition) 3. M.D., A. D. (Director) (2014, July 21). Surgical Management of Traumatic Rib Fractures. Lecture conducted from , Springfield, MA. 4. Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. (0001, January 18). Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis. Retrieved July 16, 2014 5. REDCap. (n.d.). REDCap. Retrieved August 4, 2014, from https://collaborate.tuftsctsi.org/redcap/ 6. SRF Abstract by Dr. Andrew Doben, M.D. 7. Swedish Medical Center Seattle and Issaquah. (n.d.). Swedish. Retrieved July 16, 2014, from http://www.swedish.org/about/blog/august-2012/rib-fractures-essentials-of-management- treatment 8. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. (n.d.). AccessMedicine. Retrieved July 16, 2014, from http://accessmedicine.mhmedical.com/content.aspx?bookid=348§ionid=40381746&jumpsect ionID=40408000&Resultclick=2 9. TRAUMA.ORG: Thoracic Trauma. (n.d.). TRAUMA.ORG: Thoracic Trauma. Retrieved July 16, 2014, from http://www.trauma.org/archive/thoracic/CHESTflail.html(flail chest definition)

Hinweis der Redaktion

  • Talk about flail chest and the effects it has on pulmonary function… how would flail chest be treated if SRF was unavailable?
    Give background info on the severity of rib fractures and the complications that can follow… also talk about how they are treated and the risks of poor treatment
    What exactly is SRF and how does baystate manage rib fracture cases?
    How did we conduct this study/what was the protocol for our research?
    What are the future plans for SRF?

  • Flail Chest is defined as a loss of stability of the chest wall due to three or
    more ribs that are broken in two or more places as a result of a crushing
    chest injury. (THIS IS AN ANTIQUATED DEFINITION)…The loose chest segment moves in a direction in the reverse of
    normal; that is, the segment moves inward during inhalation and outward
    during exhalation (also known as paradoxical respiration).
  • The frequency of flail chest is 150/100K injuries
    Rib fractures remain a major source of morbidity and although there have been advances in pain control, the outcomes have not improved
    The safety and efficiency of SRF remains uncertain because few studies have been conducted, especially in the age>65 population
  • Chest deformity and permanent respiratory struggles
    60% never return to work
  • Different types of SRF procedures
  • A quick slide showing a summarized view of the SRF process using Synthes Rib Matrix
  • The Baystate team has created a multidisciplinary team approach in the care of fractured ribs
    There are specific pain regimens and surgical interventions
    All patients whom underwent SRF were reviewed in our study
    This group of patients was then sub-divided into age <65 and age >65 presentation groups
    Data was analyzed, revealing similarities between the two group
  • Wording? Who did we choose and why?
  • REDCap was the database software that was utilized for this study
    Outcome variables
  • It was observed that the two study groups, ages > 65 and ages <64 were nearly identical in all variable outcomes. The median number of ventilator days, ISS, ICU LOS, and Hospital LOS were similar in both groups, signaling that there should not be age restrictions on surgical rib fixations.
  • Our results are consistent with others like it. We hope to present this data at a national conference where we will encourage other institutions to begin to share their data and outcomes of surgical rib fixation to create a national registry that perhaps will help determine the overall benefit to patients.
  • Do I need these slides?