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. 2022 Jun 1;92(6):967-973.
doi: 10.1097/TA.0000000000003535. Epub 2022 Feb 4.

Prospective validation of the Rib Injury Guidelines for traumatic rib fractures

Adam Nelson  1 , Raul Reina, Ashley Northcutt, Omar Obaid, Lourdes Castanon, Michael Ditillo, Lynn Gries, Letitia Bible, Tanya Anand, Bellal Joseph
Affiliations

Prospective validation of the Rib Injury Guidelines for traumatic rib fractures

Adam Nelson et al. J Trauma Acute Care Surg. .

Abstract

Introduction: The Rib Injury Guidelines (RIG) were developed to guide triage of traumatic rib fracture patients to home, regular floor, or intensive care unit (ICU) and standardize care. The RIG score is based on patient history, physical examination, and imaging findings. The aim of this study was to evaluate triage effectiveness and health care resources utilization following RIG implementation.

Methods: This is a prospective analysis at a level I trauma center from October 2017 to January 2020. Adult (18 years or older) blunt trauma patients with a diagnosis of at least one rib fracture on computed tomography imaging were included. Patients before (PRE) and after (POST) implementation of RIG were compared. In the POST group, patients were divided into RIG 1, RIG 2, and RIG 3 based on their RIG score. Outcomes were readmission for RIG 1 patients, unplanned ICU admission for RIG 2 patients, and overall ICU admission. Secondary outcomes were hospital length of stay (LOS) and mortality.

Results: A total of 1,100 patients were identified (PRE, 754; POST, 346). Mean ± SD age was 56 ± 19 years, 788 (71.6%) were male, and median Injury Severity Score was 14 (range, 10-22). The most common mechanism of injury was motor vehicle collision (554 [50.3%]), 253 patients (22.9%) had ≥5 rib fractures, and 53 patients (4.8%) had a flail chest. In the POST group, 74 patients (21.1%) were RIG 1; 121 (35.2%), RIG 2; and 151 (43.7%), RIG 3. No patient in RIG 1 was readmitted following initial discharge, and two patients (1.6%) in RIG 2 had an unplanned ICU admission (both for alcohol withdrawal syndrome). Patients after implementation of RIG had shorter hospital LOS (3 [1-6] vs. 4 [1-7] days; p = 0.019) and no difference in mortality (5.8% vs. 7.7%; p = 0.252). On multivariate analysis, RIG implementation was associated with decreased ICU admission (adjusted odds ratio, 0.55 [0.36-0.82]; p = 0.004).

Conclusion: Rib Injury Guidelines are safe and effectively define triage of rib fracture patients with an overall reduction in ICU admissions, shorter hospital LOS, and no readmissions.

Level of evidence: Therapeutic/care management, level III.

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References

    1. Leadership TACoSCoT. National Trauma Data Bank (NTDB) Annual Report 2007 . Chicago, IL: American College of Surgeons Committee on Trauma; 2007.
    1. Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open . 2017;2(1):e000064.
    1. Peek J, Ochen Y, Saillant N, Groenwold RHH, Leenen LPH, Uribe-Leitz T, Houwert RM, Heng M. Traumatic rib fractures: a marker of severe injury. A nationwide study using the National Trauma Data Bank. Trauma Surg Acute Care Open . 2020;5(1):e000441.
    1. Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg . 2003;23(3):374–378.
    1. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma . 1994;37(6):975–979.

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