The long-term treatment trends of splenic injuries can provide guidance when treating trauma patients. The nonoperative management (NOM) of splenic injuries was introduced in early 1989. After decades of development, it has proven to be safe and is now the primary treatment choice worldwide. However, there remains a lack of nationwide registry data to support the feasibility and efficiency of NOM. We used the Taiwan National Health Insurance Research Database to conduct a whole population-based cohort study. Patients admitted with blunt splenic injuries from 2002 to 2013 were identified. Demographic data, management methods, associated injuries, comorbidities and outcome parameters were collected. Patients were divided into 2 groups by the type of admitting institution: a tertiary center or a non-center hospital. We also used 4 years as an interval to analyze the changes in epidemiological data and treatment trends. Comparisons of the results of NOM and surgical management were also performed. A total of 12,455 patients were admitted with blunt splenic injuries between 2002 and 2013. Among the 11,551 patients treated in a single hospital after admission, patients underwent NOM more frequently at tertiary centers than at non-center hospitals (64.6% vs 50.3%). During the 12-year study period, the NOM rate increased from 56 to 73% in tertiary centers, while in noncenter hospitals, the rate only increased from 43 to 58%. The mortality rate decreased in tertiary centers from 8.9 to 7.2%, with no apparent change in noncenter hospitals. Complications occurred more frequently in the surgical management group. There is a trend toward the use of NOM for blunt splenic injury treatments, and the outcomes from the NOM groups were not inferior to those of the operation group. In addition, tertiary centers performed more NOM than did non-center hospitals and better met the international consensus.

Background: Multiple rib fractures is a common chest trauma with a significant and sustained impact on pulmonary function and quality of life. Continuous monitoring of the pulmonary function parameter was necessary to adjust the therapeutic goals in these patients. We developed an internet-based remote system for lung function monitoring with a remote spirometry and smart device application to follow up these patients consecutively. Method: From Jan 2021 to April 2021, we conducted a prospective study that applied an intelligent spirometry system for patients with multiple rib fractures. With informed consent, we collected clinical data from them and introduced the remote spirometry system. We followed up with these patients for 12 weeks after trauma and compared the recovery of pulmonary function parameters and clinical outcomes. Result: A total of 21 patients were enrolled in our study. We divided them into two groups by the compliance to this remote spirometry system. The improvement of forced vital capacity was better in the good compliance group than the poor compliance group (110% versus 21%, p value 0.049). Moreover, the complication rate was also lower in the good compliance group than the poor compliance group (10% versus 66.7% p value 0.017). Conclusions: Remote spirometry system is a novel system that can help in lung rehabilitation in patients with multiple rib fractures. Patients that cooperate well with this system presented superior lung function improvement and inferior complication rate.

Rib fractures (RF) are a common injury that cause significant morbidity and mortality, especially in geriatric patients. RF fixation could shorten hospital stay and improve survival. The aim of this retrospective study was to evaluate the clinical impact and proper surgical timing of RF fixation in geriatric patients. We reviewed all the medical data of patients older than 16 years old with RF from the trauma registry database between January 2017 and December 2019 in Chang Gung Memorial Hospital. A total of 1078 patients with RF were enrolled, and 87 patients received RF fixation. The geriatric patients had a higher chest abbreviated injury scale than the non-geriatric group (p = 0.037). Univariate analysis showed that the RF fixation complication rates were significantly related to the injury severity scores (Odds ratio 1.10, 95% CI 1.03–1.20, p = 0.009) but not associated with age (OR 0.99, 95% CI 0.25–3.33, p = 0.988) or the surgical timing (OR 2.94, 95% CI 0.77–12.68, p = 0.122). Multivariate analysis proved that only bilateral RF was an independent risk factor of complications (OR 6.60, 95% CI 1.38–35.54, p = 0.02). RF fixation can be postponed for geriatric patients after they are stabilized and other lethal traumatic injuries are managed as a priority.

Introduction: Multiple rib fractures are common injuries resulting from blunt chest trauma. However, the effect of rib fracture displacement on pulmonary ventilation remains unclear. This study aimed to investigate the effect of severely displaced ribs on pulmonary ventilation function (PVF) 3 months post-trauma. Materials and methods: This retrospective case–control study was conducted at Chang Gung Memorial Hospital. Patients with multiple rib fractures (≥ 3) who underwent chest computed tomography (CT) from January 2019 to September 2023 were included. Patient demographics, injury severity, and rib fracture morphology were assessed. Displaced rib fractures were defined as bicortical displacements observed on CT. PVF was measured using forced vital capacity (FVC) and forced expiratory volume in 1 s. Univariate and multivariate logistic and linear regression analyses were performed to determine whether displaced rib fractures significantly affected PVF 3 months post-trauma. Results: Overall, 111 patients with multiple rib fractures were included. Displaced rib fractures were identified as an independent risk factor for having FVC < 80% at 3 months post-trauma, with each additional severely displaced rib increasing the odds by 31% (odds ratio: 1.31, 95% CI 1.09–1.57, p = 0.004). Subgroup analysis revealed that this effect was particularly significant in patients with non-flail chests. The receiver operating characteristic curve and Youden index identified that the optimal cutoff value for significantly displaced rib fractures affecting PVF was three or more fractures. Conclusion: Severely displaced rib fractures significantly impact PVF 3 months post-trauma.

Article: Opposite effects of Covid-19 infection on pitchers and batters: a retrospective study on Chinese Professional Baseball League players - The Journal of Sports Medicine and Physical Fitness 2023 Oct 06 - Minerva Medica - Journals