Prediction of pulmonary morbidity and mortality in patients with femur fracture

Kelly A. Lefaivre, Adam J. Starr, Philip F. Stahel, Alan C. Elliott, Wade R. Smith

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: We aimed to determine the effect of femur fractures on mortality, pulmonary complications, and adult respiratory distress syndrome (ARDS). In addition, we aimed to compare the effect of femur fractures with other major musculoskeletal injuries and to determine the effect of timing to surgery on these complications. Methods: All patients were identified from the trauma registries of two Level I trauma centers. Outcomes were defined at mortality in hospital, pulmonary complications, and ARDS in hospital. Regression analysis was used to determine the effect of femur fractures, while controlling for age, Abbreviated Injury Scales, Glasgow Coma Scale, and systolic blood pressure at presentation. We compared femur fractures with other major musculoskeletal injuries in similar models. Within the patients with femur fracture, time to surgery (<8 hours, 8 hours to 24 hours, and >24 hours) was evaluated using similar regression analysis. Results: Of the total 90,510 patients, 3,938 (4.35%) died in the hospital, 2,055 (2.27%) had a pulmonary complication, and 285 (0.31%) developed ARDS. Femur fracture is statistically predictive of mortality (odds ratio [OR], 1.606; 95% confidence interval [CI], 1.288-2.002) and pulmonary complications (OR, 1.659; 95% CI, 1.329-2.070), when controlling for other injury factors. This was comparable with the effect of pelvic fracture and other major musculoskeletal injuries. Femur fracture had a strong relationship with ARDS (OR, 2.129; 95% CI, 1.382-3.278). Patients treated in the 8 hours to 24 hours window had the lowest mortality risk (OR, 0.140; 95% CI, 0.052-0.375), and there was a trend to increased risk of ARDS in a delay to surgery of >24 hours. Conclusions: Femur fractures are a major musculoskeletal injury and increase the risk of mortality and pulmonary complications as much as any other musculoskeletal injuries. There is a unique relationship between ARDS and femur fractures, and this must be considered carefully in treatment planning for these patients.

Original languageEnglish (US)
Pages (from-to)1527-1536
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume69
Issue number6
DOIs
StatePublished - Dec 2010

Fingerprint

Femur
Adult Respiratory Distress Syndrome
Morbidity
Lung
Mortality
Wounds and Injuries
Odds Ratio
Confidence Intervals
Abbreviated Injury Scale
Regression Analysis
Blood Pressure
Glasgow Coma Scale
Trauma Centers
Hospital Mortality
Registries

Keywords

  • Adult respiratory distress syndrome
  • Femur fracture
  • Respiratory complication
  • Trauma mortality

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Prediction of pulmonary morbidity and mortality in patients with femur fracture. / Lefaivre, Kelly A.; Starr, Adam J.; Stahel, Philip F.; Elliott, Alan C.; Smith, Wade R.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 69, No. 6, 12.2010, p. 1527-1536.

Research output: Contribution to journalArticle

Lefaivre, Kelly A. ; Starr, Adam J. ; Stahel, Philip F. ; Elliott, Alan C. ; Smith, Wade R. / Prediction of pulmonary morbidity and mortality in patients with femur fracture. In: Journal of Trauma - Injury, Infection and Critical Care. 2010 ; Vol. 69, No. 6. pp. 1527-1536.
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abstract = "Background: We aimed to determine the effect of femur fractures on mortality, pulmonary complications, and adult respiratory distress syndrome (ARDS). In addition, we aimed to compare the effect of femur fractures with other major musculoskeletal injuries and to determine the effect of timing to surgery on these complications. Methods: All patients were identified from the trauma registries of two Level I trauma centers. Outcomes were defined at mortality in hospital, pulmonary complications, and ARDS in hospital. Regression analysis was used to determine the effect of femur fractures, while controlling for age, Abbreviated Injury Scales, Glasgow Coma Scale, and systolic blood pressure at presentation. We compared femur fractures with other major musculoskeletal injuries in similar models. Within the patients with femur fracture, time to surgery (<8 hours, 8 hours to 24 hours, and >24 hours) was evaluated using similar regression analysis. Results: Of the total 90,510 patients, 3,938 (4.35{\%}) died in the hospital, 2,055 (2.27{\%}) had a pulmonary complication, and 285 (0.31{\%}) developed ARDS. Femur fracture is statistically predictive of mortality (odds ratio [OR], 1.606; 95{\%} confidence interval [CI], 1.288-2.002) and pulmonary complications (OR, 1.659; 95{\%} CI, 1.329-2.070), when controlling for other injury factors. This was comparable with the effect of pelvic fracture and other major musculoskeletal injuries. Femur fracture had a strong relationship with ARDS (OR, 2.129; 95{\%} CI, 1.382-3.278). Patients treated in the 8 hours to 24 hours window had the lowest mortality risk (OR, 0.140; 95{\%} CI, 0.052-0.375), and there was a trend to increased risk of ARDS in a delay to surgery of >24 hours. Conclusions: Femur fractures are a major musculoskeletal injury and increase the risk of mortality and pulmonary complications as much as any other musculoskeletal injuries. There is a unique relationship between ARDS and femur fractures, and this must be considered carefully in treatment planning for these patients.",
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AU - Starr, Adam J.

AU - Stahel, Philip F.

AU - Elliott, Alan C.

AU - Smith, Wade R.

PY - 2010/12

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N2 - Background: We aimed to determine the effect of femur fractures on mortality, pulmonary complications, and adult respiratory distress syndrome (ARDS). In addition, we aimed to compare the effect of femur fractures with other major musculoskeletal injuries and to determine the effect of timing to surgery on these complications. Methods: All patients were identified from the trauma registries of two Level I trauma centers. Outcomes were defined at mortality in hospital, pulmonary complications, and ARDS in hospital. Regression analysis was used to determine the effect of femur fractures, while controlling for age, Abbreviated Injury Scales, Glasgow Coma Scale, and systolic blood pressure at presentation. We compared femur fractures with other major musculoskeletal injuries in similar models. Within the patients with femur fracture, time to surgery (<8 hours, 8 hours to 24 hours, and >24 hours) was evaluated using similar regression analysis. Results: Of the total 90,510 patients, 3,938 (4.35%) died in the hospital, 2,055 (2.27%) had a pulmonary complication, and 285 (0.31%) developed ARDS. Femur fracture is statistically predictive of mortality (odds ratio [OR], 1.606; 95% confidence interval [CI], 1.288-2.002) and pulmonary complications (OR, 1.659; 95% CI, 1.329-2.070), when controlling for other injury factors. This was comparable with the effect of pelvic fracture and other major musculoskeletal injuries. Femur fracture had a strong relationship with ARDS (OR, 2.129; 95% CI, 1.382-3.278). Patients treated in the 8 hours to 24 hours window had the lowest mortality risk (OR, 0.140; 95% CI, 0.052-0.375), and there was a trend to increased risk of ARDS in a delay to surgery of >24 hours. Conclusions: Femur fractures are a major musculoskeletal injury and increase the risk of mortality and pulmonary complications as much as any other musculoskeletal injuries. There is a unique relationship between ARDS and femur fractures, and this must be considered carefully in treatment planning for these patients.

AB - Background: We aimed to determine the effect of femur fractures on mortality, pulmonary complications, and adult respiratory distress syndrome (ARDS). In addition, we aimed to compare the effect of femur fractures with other major musculoskeletal injuries and to determine the effect of timing to surgery on these complications. Methods: All patients were identified from the trauma registries of two Level I trauma centers. Outcomes were defined at mortality in hospital, pulmonary complications, and ARDS in hospital. Regression analysis was used to determine the effect of femur fractures, while controlling for age, Abbreviated Injury Scales, Glasgow Coma Scale, and systolic blood pressure at presentation. We compared femur fractures with other major musculoskeletal injuries in similar models. Within the patients with femur fracture, time to surgery (<8 hours, 8 hours to 24 hours, and >24 hours) was evaluated using similar regression analysis. Results: Of the total 90,510 patients, 3,938 (4.35%) died in the hospital, 2,055 (2.27%) had a pulmonary complication, and 285 (0.31%) developed ARDS. Femur fracture is statistically predictive of mortality (odds ratio [OR], 1.606; 95% confidence interval [CI], 1.288-2.002) and pulmonary complications (OR, 1.659; 95% CI, 1.329-2.070), when controlling for other injury factors. This was comparable with the effect of pelvic fracture and other major musculoskeletal injuries. Femur fracture had a strong relationship with ARDS (OR, 2.129; 95% CI, 1.382-3.278). Patients treated in the 8 hours to 24 hours window had the lowest mortality risk (OR, 0.140; 95% CI, 0.052-0.375), and there was a trend to increased risk of ARDS in a delay to surgery of >24 hours. Conclusions: Femur fractures are a major musculoskeletal injury and increase the risk of mortality and pulmonary complications as much as any other musculoskeletal injuries. There is a unique relationship between ARDS and femur fractures, and this must be considered carefully in treatment planning for these patients.

KW - Adult respiratory distress syndrome

KW - Femur fracture

KW - Respiratory complication

KW - Trauma mortality

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