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Patient-reported outcomes 6 to 12 months after isolated rib fractures: A nontrivial injury pattern
Patrick Heindel1, Alexander Ordoobadi, Mohamad El Moheb
1From the Division of Trauma, Burn and Surgical Critical Care, Department of Surgery (P.H., A.O., M.E.M., A.S.), and Center for Surgery and Public Health (P.H., A.O., M.E.M., J.S.-G., S.G., A.H., N.P., J.H.E., A.S., D.N.), Brigham and Women's Hospital, Harvard Medical School; Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery (S.S.), Boston University School of Medicine, Boston, Massachusetts; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (H.M.A.K.), Massachusetts General Hospital, Harvard Medical School; and Division of Trauma, Burn and Critical Care Surgery, Department of Surgery (D.N.), University of Washington Medical Center, Seattle, Washington.
Background:
Despite the ubiquity of rib fractures in patients with blunt chest trauma, long-term outcomes for patients with this injury pattern are not well described.
Methods:
The Functional Outcomes and Recovery after Trauma Emergencies (FORTE) project has established a multicenter prospective registry with 6- to 12-month follow-up for trauma patients treated at participating centers. We combined the FORTE registry with a detailed retrospective chart review investigating admission variables and injury characteristics. All trauma survivors with complete FORTE data and isolated chest trauma (Abbreviated Injury Scale score of ≤1 in all other regions) with rib fractures were included. Outcomes included chronic pain, limitation in activities of daily living, physical limitations, exercise limitations, return to work, and both inpatient and discharge pain control modalities. Multivariable logistic regression models were built for each outcome using clinically relevant demographic and injury characteristic univariate predictors.
Results:
We identified 279 patients with isolated rib fractures. The median age of the cohort was 68 years (interquartile range, 56-78 years), 59% were male, and 84% were White. Functional and quality of life limitations were common among survivors of isolated rib fractures even 6 to 12 months after injury. Forty-three percent of patients without a preexisting pain disorder reported new daily pain, and new chronic pain was associated with low resilience. Limitations in physical functioning and exercise capacity were reported in 56% and 51% of patients, respectively. Of those working preinjury, 28% had not returned to work. New limitations in activities of daily living were reported in 29% of patients older than 65 years. Older age, higher number of rib fractures, and intensive care unit admission were independently associated with higher odds of receiving regional anesthesia. Receiving a regional nerve block did not have a statistically significant association with any patient-reported outcome measures.
Conclusion:
Isolated rib fractures are a nontrivial trauma burden associated with functional impairment and chronic pain even 6 to 12 months after injury.
Level Of Evidence:
Prognostic/epidemiologic, level III.
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