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. 2021 Nov-Dec;28(6):386-394.
doi: 10.1097/JTN.0000000000000618.

Improving Blunt Chest Wall Injury Outcomes: Introducing the PIC Score

Shawn M Terry  1 , Kimberly A Shoff, Mark L Sharrah
Affiliations

Improving Blunt Chest Wall Injury Outcomes: Introducing the PIC Score

Shawn M Terry et al. J Trauma Nurs. 2021 Nov-Dec.

Abstract

Background: To improve care for nonintubated blunt chest wall injury patients, our Level I trauma center developed a treatment protocol and a pulmonary evaluation tool named "PIC Protocol" and "PIC Score," emphasizing continual assessment of pain, incentive spirometry, and cough ability.

Objective: The primary objective was to reduce unplanned intensive care unit admissions for blunt chest wall injury patients using the PIC Protocol and the PIC Score. Additional outcomes included intensive care unit length of stay, ventilator days, length of hospital stay, inhospital mortality, and discharge destination.

Methods: This was a retrospective cohort study comparing outcomes of rib fracture patients treated at our facility 2 years prior to (control group) and 2 years following PIC Protocol use (PIC group). The protocol included admission screening, a power plan order set, the PIC Score patient assessment tool, in-room communication board, and patient education brochure. Outcomes were compared using independent-samples t tests for continuous variables and Pearson's χ2 for categorical variables with α set to p < .05.

Results: There were 1,036 patients in the study (control = 501; PIC = 535). Demographics and injury severity were similar between groups. Unanticipated escalations of care for acute pulmonary distress were reduced from 3% (15/501) in the control group to 0.37% (2/535) in the PIC group and were predicted by a preceding fall in the PIC Score of 3 points over the previous 8-hr shift, marking pulmonary decline by an acutely falling PIC Score.

Conclusions: The PIC Protocol and the PIC Score are easy-to-use, cost-effective tools for guiding care of blunt chest wall injury patients.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Alexander J. Q., Gutierrez C. J., Mariano M. C., Vander Laan T., Gaspard D. J., Carpenter C. L., Stain S. C. (2000). Blunt chest trauma in the elderly patient: How cardiopulmonary disease affects outcome. American Surgeon, 66(9), 855–857.
    1. Bakhos C., O'Connor J., Kyriakides T., Abou-Nukta F., Bonadies J. (2006). Vital capacity as a predictor of outcome in elderly patients with rib fractures. Journal of Trauma and Acute Care Surgery, 61(1), 131–134. https://doi.org/10.1097/01.ta.0000223463.88422.6a - DOI
    1. Battle C. E., Hutchings H., Evans P. A. (2012). Risk factors that predict mortality in patients with blunt chest wall trauma: A systematic review and meta-analysis. Injury, 43(1), 8–17. https://doi.org/10.1016/j.injury.2011.01.004 - DOI
    1. Battle C. E., Hutchings H., Lovett S., Bouamra O., Jones S., Sen A., Gagg J., Robinson D., Hartford-Beynon J., Williams J., Evans A. (2014). Predicting outcomes after blunt chest wall trauma: Development and external validation of a new prognostic model. Critical Care, 18(3), R98. https://doi.org/10.1186/cc13873 - DOI
    1. Brasel K. J., Moore E. E., Albrecht R. A., deMoya M., Schreiber M., Karmy-Jones R., Rowell S., Namias N., Cohen M., Shatz D. V., Biffl W. L. (2017). Western Trauma Association critical decisions in trauma: Management of rib fractures. Journal of Trauma and Acute Care Surgery, 82(1), 200–203. https://doi.org/10.1097/TA.0000000000001301 - DOI