{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:19:42Z","timestamp":1792034382539,"version":"4.4.0"},"reference-count":20,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T00:00:00Z","timestamp":1529366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T00:00:00Z","timestamp":1529366400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Flail chest is considered a highly morbid condition with reported mortality ranging from 10 to 20%. It is often associated with other severe injuries, which may complicate management and interpretation of outcomes. The physiologic impact and prognosis of isolated flail chest injury is poorly defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a National Trauma Databank study. All patients from 1\/2007 to 12\/2014 admitted with flail chest were extracted. Patients with head or abdominal AIS \u22653, dead on arrival, or transferred, were excluded. Primary outcome was mortality; secondary outcomes were need for mechanical ventilation and pneumonia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 1,047,519 patients with blunt chest injury, 14,718 (1.4%) patients presented with flail chest, and 8098 (0.77%) met inclusion criteria. The most commonly associated intrathoracic injuries were hemothorax (57.9%) and lung contusions (63.0%), while sternal fracture (8.8%) and cardiac contusion (2.5%) were less common. In total, 29.8% of patients required mechanical ventilation, and 11.2% developed pneumonia. Overall mortality was 5.6%. On multivariable analysis, age &gt;65 and need for mechanical ventilation were independent risk factors for mortality (OR 6.02, 3.75, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Independent predictors for mechanical ventilation included cardiac or pulmonary contusion and sternal fractures (OR 3.78, 2.38, 2.29, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Need for mechanical ventilation was an independent predictor of pneumonia (OR 13.18, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Mortality in isolated flail chest is much lower than previously reported. Fewer than 30% of patients require mechanical ventilation. Need for mechanical ventilation, however, is independently associated with mortality and pneumonia. Age &gt;65 is an independent risk factor for adverse outcomes, and these patients may benefit by more aggressive monitoring and treatment.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4723-6","type":"journal-article","created":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T15:18:41Z","timestamp":1529421521000},"page":"3927-3931","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Flail Chest: Less Deadly than Originally Thought"],"prefix":"10.1002","volume":"42","author":[{"given":"Elizabeth","family":"Benjamin","sequence":"first","affiliation":[{"name":"Division of Trauma and Critical Care University of Southern California Los Angeles CA USA"},{"name":"Los Angeles County Medical Center\u2009+\u2009USC 2051 Marengo St, Inpatient Tower, C5L\u2010100 90033 Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Recinos","sequence":"additional","affiliation":[{"name":"Division of Trauma and Critical Care University of Southern California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Aiolfi","sequence":"additional","affiliation":[{"name":"Division of Trauma and Critical Care University of Southern California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Inaba","sequence":"additional","affiliation":[{"name":"Division of Trauma and Critical Care University of Southern California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demetrios","family":"Demetriades","sequence":"additional","affiliation":[{"name":"Division of Trauma and Critical Care University of Southern California Los Angeles CA 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