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Improving Blunt Chest Wall Injury Outcomes: Introducing the PIC Score
Shawn M Terry1, Kimberly A Shoff, Mark L Sharrah
1Departments of Trauma and Critical Care Surgery (Dr Terry) and Trauma Services (Ms Shoff and Mr Sharrah), WellSpan Health-York Hospital, York, Pennsylvania.
Insights
The PIC Protocol and PIC Score significantly reduced unplanned ICU admissions for blunt chest wall injury patients. This continuous assessment tool effectively guides care and predicts pulmonary decline.
Area of Science:
- Trauma Surgery
- Pulmonary Medicine
- Critical Care
Background:
- Nonintubated patients with blunt chest wall injuries require effective management strategies.
- A Level I trauma center developed the PIC Protocol and PIC Score to enhance care.
- The protocol emphasizes continuous assessment of pain, incentive spirometry, and cough ability.
Purpose of the Study:
- To decrease unplanned intensive care unit (ICU) admissions for blunt chest wall injury patients.
- To evaluate the impact of the PIC Protocol and PIC Score on ICU length of stay, ventilator days, and hospital stay.
- To assess effects on in-hospital mortality and discharge destination.
Main Methods:
- Retrospective cohort study comparing patients before and after protocol implementation.
- The PIC Protocol included screening, a power plan, the PIC Score tool, communication boards, and patient education.
- Statistical analysis used independent-samples t tests and Pearson's χ2, with p < .05 as the significance level.
Main Results:
- A total of 1,036 patients were analyzed (501 control, 535 PIC group).
- Unanticipated escalations of care for acute pulmonary distress decreased from 3% to 0.37% with the PIC Protocol.
- A fall in the PIC Score by 3 points over 8 hours predicted pulmonary decline.
Conclusions:
- The PIC Protocol and PIC Score are user-friendly and cost-effective.
- These tools effectively guide the management of blunt chest wall injury patients.
- The protocol demonstrated a significant reduction in adverse pulmonary events.
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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