Evidence map›Paper›PMID 41758337›Full record

ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026

Pain management in non-operatively treated patients with multiple single rib fractures: an international comparison.

Tiemen E T Holtrop, Yasmin Arda, George C Velmahos, Pieta Krijnen, Inger B Schipper, Joshua S Ng-Kamstra, Erwin A Gorter

Abstract readComparative Study
PubMed Full text at PMC Publisher
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Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Tiemen E T HoltropDepartment of Trauma Surgery, Leiden University Medical Center, Postzone K6-R, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.
Yasmin ArdaDivision of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA.
George C VelmahosDivision of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA.
Pieta KrijnenDepartment of Trauma Surgery, Leiden University Medical Center, Postzone K6-R, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.
Inger B SchipperDepartment of Trauma Surgery, Leiden University Medical Center, Postzone K6-R, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.
Joshua S Ng-Kamstra *Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. jng-kamstra@mgh.harvard.edu.
Erwin A Gorter *Department of Trauma Surgery, Leiden University Medical Center, Postzone K6-R, P.O. Box 9600, Leiden, 2300 RC, The Netherlands. e.a.gorter@lumc.nl.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeEvidence on non-operative management of multiple single rib fractures remains limited, resulting in institutional treatment variation. This study compared outcomes of different pain management strategies.

methodsA retrospective cohort study at Massachusetts General Hospital (MGH, USA) and Leiden University Medical Center (LUMC, The Netherlands) included patients ≥ 18 years with ≥ 3 single rib fractures between 2018 and 2023. Exclusion criteria included flail chest, surgical fixation, severe extra-thoracic trauma, Glasgow Coma Scale < 15 after 72 h, and transfers. Primary outcomes were pain score change, discharge opioid use, and pulmonary complications. Secondary outcomes included mortality and hospital length of stay (HLOS). Subgroup analysis compared fracture side and displacement, and ICU admission. Forward stepwise logistic regression analysis identified predictors of pneumonia.

results545 patients were included (109 at LUMC). LUMC patients were younger (61 vs. 68 years, p < 0.001) with fewer comorbidities but higher injury severity scores (13 vs. 10, p < 0.001). LUMC favored patient-controlled analgesia (22.9% vs. 5.7%, p < 0.001) and less provider-controlled opioids (11.0% vs. 21.3%, p < 0.001). Pain score reduction (4 vs. 4, p = 0.68), discharge opioid use (45 vs. 45 oral morphine equivalents, p = 0.75), HLOS (3 vs. 4 days, p = 0.059), pulmonary complications (3.7% vs. 6.2%, p = 0.31), and mortality (2.8% vs. 1.8%, p = 0.54) were similar. Bilateral and displaced fractures required ICU admission more often but had similar outcomes. Congestive heart failure (OR 14.86, 95%CI 3.24–68.16, p = 0.001) and chronic obstructive pulmonary disease (OR 8.08, 95%CI 1.72–38.03, p = 0.008) independently predicted pneumonia.

conclusionDespite differences in patient characteristics and pain management, outcomes were similar. Hospital level treatment heterogeneity may be acceptable when tailored to patient needs, questioning the need for rigid guidelines.

Indexed as

Fractures, MultiplePain ManagementRib FracturesAgedAnalgesia, Patient-ControlledAnalgesics, OpioidFemaleHumansInjury Severity ScoreLength of StayMaleMiddle AgedNetherlandsPain MeasurementRetrospective StudiesAnalgesics, OpioidChest traumaInternational comparisonOpioidPain managementRib fracturesTreatment variation

Identifiers

PMID41758337
PMCPMC12948914

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.