scholarly journals Potential benefits of incentive spirometry following a rib fracture: a propensity score analysis

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 464-467 ◽  
Author(s):  
Brice Lionel Batomen Kuimi ◽  
Antoine Lague ◽  
Valérie Boucher ◽  
Chantal Guimont ◽  
Jean-Marc Chauny ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Pulmonary Complications ◽  
Rib Fracture ◽  
Score Analysis ◽  
Potential Benefits ◽  
Observational Cohort ◽  
Respiratory Recovery ◽  
Attending Physician ◽  
Incentive Spirometry

ABSTRACTObjectivesIncentive Spirometry is commonly used for respiratory recovery. The literature on incentive spirometry and its impact on patients with rib fracture is unclear and there are no recommendations regarding its use in the Emergency Department (ED), particularly in rib fracture patients, which are known for increasing the risk of pulmonary complication. Therefore, the objective of this study was to assess the use of incentive spirometry and to measure its impacts on delayed complications in patients discharged from the ED with confirmed rib fracture.MethodsThis is a planned sub-study of a prospective observational cohort recruited in 4 Canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with at least one confirmed rib fracture on radiographs were included. Prescription of incentive spirometry was left to attending physician. Main outcomes were development of pneumonia, atelectasis, and hemothorax within 14 days. Propensity score matching analyses were performed.Results439 patients were included and 182 (41.5%) patients received incentive spirometry. There were 99 cases of hemothorax (22.6%), 103 cases of atelectasis (23.5%) and 4 cases of pneumonia (0.9%). The use of incentive spirometry was not protector for hemothorax [RR = 1.03 (0.66–1.64)] and atelectasis or pneumonia [RR = 1.07 (0.68–1.72)].ConclusionsOur results suggest that unsupervised incentive spirometry use does not have a protective effect against delayed pulmonary complications after rib fracture. Further research should be conducted to assess the usefulness of incentive spirometry in specific injured population in the ED.

scholarly journals Potential benefits of incentive spirometry following a rib fracture: a propensity-score analysis – CORRIGENDUM

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
Author(s):  
Brice Lionel Batomen Kuimi ◽  
Antoine Lague ◽  
Valérie Boucher ◽  
Chantal Guimont ◽  
Jean-Marc Chauny ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Rib Fracture ◽  
Score Analysis ◽  
Potential Benefits ◽  
Incentive Spirometry

scholarly journals P085: Potential benefits of incentive spirometry following a rib fracture: a propensity-score analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S87-S87
Author(s):  
M. Emond ◽  
A. Laguë ◽  
B. Batomen Kuimi ◽  
V. Boucher ◽  
C. Guimont ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Pulmonary Complications ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Thoracic Injury ◽  
Main Complaint ◽  
Score Analysis ◽  
Discharged Patients ◽  
Incentive Spirometry

Introduction: Incentive spirometry (IS) is commonly used in post-operative patients for respiratory recovery. Literature suggest that it can possibly improve lung function and reduce post-operative pulmonary complication. There is no recommendation about the use of IS in the emergency department (ED). However, rib fractures, a common complaint, increase the risk of pulmonary complications. There is heterogeneous ED practice for the management of rib fractures. The objective of this study is to assess the benefits of IS to reduce potential delayed complications in ED discharged patients with confirmed rib fracture. Methods: This is a prospective observational planned sub-study in 4 canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with a main complaint of minor thoracic injury and at least one suspected/confirmed rib fracture on radiographs were included. Discharge recommendations of IS use was left to attending physician. IS training was done by ED nurses. Main outcomes were pneumonia, atelectasis and hemothorax within 14 days. Analyses were made with propensity score matching. Results: 450 patients with at least one rib fracture were included. Of these, 182 (40%) received IS with a mean age of 57.0 y.o. Patients with IS seem to have worse condition. 61 (33.5%) had 3 fractures comparatively to 56 (20.9) for patient without IS. Although, the groups were similar for mean age, sex and mechanism of injury. There were in total 76 cases of delayed hemothorax (16.9%), 69 cases of atelectasis (15.3%) and five cases of pneumonia (1.1%). The use of IS was not protector for delayed hemothorax (RR= 0.80, 95% CI [0.45 1.36]) and nor for atelectasis or pneumonia (RR=0.74, 95% CI [0.45 1.36]) Conclusion: Our results suggest that unsupervised and broad incentive spirometry use does not seem to add a protective effect against the development of delayed pulmonary complications after a rib fracture. Further study should be made to assess the usefulness of IS in specific injured population in the ED.

scholarly journals Routine hospital management of self-harm and risk of further self-harm: propensity score analysis using record-based cohort data

2017 ◽  
Vol 48 (2) ◽  
pp. 315-326 ◽  
Author(s):  
S. Steeg ◽  
R. Emsley ◽  
M. Carr ◽  
J. Cooper ◽  
N. Kapur
Keyword(s):  
Propensity Score ◽  
Perceived Risk ◽  
Propensity Score Analysis ◽  
Routine Care ◽  
Psychosocial Assessment ◽  
Cohort Data ◽  
Score Analysis ◽  
Outpatient Psychiatry ◽  
Observational Cohort ◽  
Self Harm

BackgroundThe care received by people presenting to hospital following self-harm varies and it is unclear how different types of treatment affect risk of further self-harm.MethodObservational cohort data from the Manchester Self-Harm Project, UK, included 16 456 individuals presenting to an Emergency Department with self-harm between 2003 and 2011. Individuals were followed up for 12 months. We also used data from a smaller cohort of individuals presenting to 31 hospitals in England during a 3-month period in 2010/2011, followed up for 6 months. Propensity score (PS) methods were used to address observed confounding. Missing data were imputed using multiple imputation.ResultsFollowing PS stratification, those who received a psychosocial assessment had a lower risk of repeat hospital attendance for self-harm than those who were not assessed [RR 0.87, 95% confidence interval (CI) 0.80–0.95]. The risk was reduced most among people less likely to be assessed. Following PS matching, we found no associations between risks of repeat self-harm and admission to a medical bed, referral to outpatient psychiatry or admission to a psychiatric bed. We did not find a relationship between psychosocial assessment and repeat self-harm in the 31 centre cohort.ConclusionsThis study shows the potential value of using novel statistical techniques in large mental health datasets to estimate treatment effects. We found that specialist psychosocial assessment may reduce the risk of repeat self-harm. This type of routine care should be provided for all individuals who present to hospital after self-harm, regardless of perceived risk.

Efficacy of variceal embolisation in patients with TIPS implantation: a propensity score analysis

2018 ◽  
Vol 56 (01) ◽  
pp. E2-E89
Author(s):  
M Giesler ◽  
D Bettinger ◽  
M Rössle ◽  
R Thimme ◽  
M Schultheiss
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Score Analysis
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