• Ceri E Battle and Phillip A Evans.
• NISCHR Haemostasis Biomedical Research Unit Epidemiology Division, Morriston Hospital, Swansea, Wales, UK.
• Emerg Med J. 2015 Dec 1; 32 (12): 961-5.

ObjectiveTo summarise the risk factors for mortality in patients with flail chest based on available evidence in the literature.MethodsA systematic review was completed using articles from PubMed, EMBASE, the Centre for Review and Dissemination database and the Cochrane Library. Additional studies were identified by hand-searching bibliographies, and grey literature was sought by searching abstracts from all relevant Emergency Medicine Conferences. All published and unpublished observational studies were included if they investigated estimates of association between a risk factor and mortality for patients with flail chest.ResultsThis review found seven studies that matched the inclusion criteria, with a total of 944 patients. Patient age of ≥65 years was reported as a predictor of mortality when controlling for injury severity score (ISS) (p<0.02, OR 2.1, 95% CI 1.0 to 4.6). An ISS of ≥31 was reported to be a predictor of mortality in two studies; however, neither controlled for patient age. Pulmonary contusion, bilateral flail chest and hospital length of stay were not consistently found to be associated with mortality.ConclusionsThe main independent predictors of mortality in patients with flail chest were reported to be increased age and ISS. More data are needed regarding the association of hospital length of stay, presence of pulmonary contusion and bilateral flail chest.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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