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

  • Brice Lionel Batomen Kuimi (a1), Antoine Lague (a1) (a2) (a3), Valérie Boucher (a1) (a2) (a3) (a4), Chantal Guimont (a3), Jean-Marc Chauny (a5) (a6), Jean-François Shields (a3), Laurent Vanier (a7), Miville Plourde (a3) and Marcel Émond (a1) (a2) (a3) (a4) (a5)...
  • Please note a correction has been issued for this article.

Abstract

Objectives

Incentive 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.

Methods

This 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.

Results

439 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)].

Conclusions

Our 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.

Objectifs

La spirométrie incitative est parfois prescrite en vue d'encourager le rétablissement de la fonction respiratoire. Toutefois, peut de littérature est disponible sur la spirométrie incitative et ses effets chez les patients avec fracture de côtes, et il n'existe pas de recommandation sur son utilisation au département des urgences (DU), tout particulièrement pour les fractures de côtes, qui sont reconnues pour accroître le risque de complications pulmonaires. Cette étude visait donc à évaluer l'utilisation de la spirométrie incitative et à mesurer son impact sur l'incidence de complications tardives chez les patients ayant été libéré de l'urgence après une confirmation de fracture de côtes.

Méthode

Il s'agit d'une sous-étude planifiée d'une étude observationnelle de cohorte prospective, qui a eu lieu dans 4 DU au Canada, entre novembre 2006 et mai 2012. Des patients âgés de 16 ans et plus, non hospitalisés, avec au moins une fracture de côte confirmée par radiographie ont été sélectionnés. La décision de prescrire la spirométrie incitative était laissée à la discrétion du médecin traitant. Les principaux résultats consistaient en l'apparition d'une pneumonie, d'atélectasie ou d'un hémothorax dans les 14 jours suivant le traumatisme. Des analyses d'appariement des coefficients de propension ont été réalisées.

Résultats

Un total de 439 patients ont participé à l’étude, dont 182 (41,5%) ont été reçu la spirométrie incitative. 99 cas d'hémothorax (22,6%), 103 cas d'atélectasie (23,5%) et 4 cas de pneumonie (0,9%) ont été observés. Nos résultats indiquent que la spirométrie incitative ne semble pas un moyen de protection contre l'hémothorax (risque relatif [RR] = 1,03 [0,66–1,64]) ni contre l'atélectasie ou la pneumonie (RR = 1,07 [0,68–1,72]).

Conclusion

Nos résultats suggèrent que la spirométrie incitative non supervisée n'offrirait pas d'effet protecteur contre l'apparition tardive de complications pulmonaires à la suite d'une fracture de côtes. D'autres recherches sont nécessaires afin de valider la pertinence de prescrire la spirométrie incitative au DU, chez certains groupes de blessés plus spécifiques.

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Copyright

Corresponding author

Correspondence to: Dr. Marcel Émond, CHU de Québec – Université Laval, 1401, 18ième rue, Québec, QB G1J 1Z4; Email: marcelemond1@me.com

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

  • Brice Lionel Batomen Kuimi (a1), Antoine Lague (a1) (a2) (a3), Valérie Boucher (a1) (a2) (a3) (a4), Chantal Guimont (a3), Jean-Marc Chauny (a5) (a6), Jean-François Shields (a3), Laurent Vanier (a7), Miville Plourde (a3) and Marcel Émond (a1) (a2) (a3) (a4) (a5)...
  • Please note a correction has been issued for this article.

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