Iatrogenic rib fractures and the associated risks of mortality



Rib fractures, though typically associated with blunt trauma, can also result from complications of medical or surgical care, including cardiopulmonary resuscitation. The purpose of this study is to describe the demographics and outcomes of iatrogenic rib fractures.


Patients with rib fractures were identified in the 2016 National Inpatient Sample. Mechanism of injury was defined as blunt traumatic rib fracture (BTRF) or iatrogenic rib fracture (IRF). IRF was identified as fractures from the following mechanisms: complications of care, drowning, suffocation, and poisoning. Differences between BTRF and IRF were compared using rank-sum test, Chi-square test, and multivariable regression.


34,644 patients were identified: 33,464 BTRF and 1180 IRF. IRF patients were older and had higher rates of many comorbid medical disorders. IRF patients were more likely to have flail chest (6.1% versus 3.1%, p < 0.001). IRF patients were more likely to have in-hospital death (20.7% versus 4.2%, p < 0.001) and longer length of hospitalization (11.8 versus 6.9 days, p < 0.001). IRF patients had higher rates of tracheostomy (30.2% versus 9.1%, p < 0.001). In a multivariable logistic regression of all rib fractures, IRF was independently associated with death (OR 3.13, p < 0.001). A propensity matched analysis of IRF and BTRF groups corroborated these findings.


IRF injuries are sustained in a subset of extremely ill patients. Relative to BTRF, IRF is associated with greater mortality and other adverse outcomes. This population is understudied. The etiology of worse outcomes in IRF compared to BTRF is unclear. Further study of this population could address this disparity.

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Availability of data and material

The National Inpatient Sample is publicly available.

Code availability

Available upon request.


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This publication was made possible by the Clinical and Translational Science Collaborative of Cleveland, KL2TR002547 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH


Clinical and Translational Science Collaborative of Cleveland, School of Medicine, Case Western Reserve University KL2TR002547 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research.

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Correspondence to Christopher W. Towe.

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Conflict of interest

VPH is supported by the Clinical and Translational Science Collaborative of Cleveland, KL2TR002547 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health. VPH spouse is consultant for Zimmer Biomet, Medtronic, Atricure, and Sig Medical. CWT is consultant for Zimmer Biomet, Medtronic, Atricure, and Sig Medical. Other authors declare no conflicts of interest.

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This study was considered exempt of IRB approval, because the data are deidentified.

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Coffey, M.R., Bachman, K.C., Ho, V.P. et al. Iatrogenic rib fractures and the associated risks of mortality. Eur J Trauma Emerg Surg (2021). https://doi.org/10.1007/s00068-020-01598-5

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  • Iatrogenic rib fractures
  • Cardiopulmonary resuscitation
  • Thoracic trauma
  • Iatrogenesis