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Published on: January 8, 2020
Impact of a rib fracture treatment protocol: a propensity score matching analysis
Thermutis Djanie1, Ashley Pfaff1, Claire Miller1
1Albany Medical College, Albany, New York, USA.
Background:
Rib fractures (RFx) increase morbidity, mortality, and resource utilization. This retrospective study aimed to evaluate the effectiveness of a novel RFx treatment protocol (RFTP) on patient outcomes.
Study Design:
We included 3679 RFx patients admitted to a single level 1 trauma center between January 2011 and October 2018. The RFTP, launched as a computer physician order entry on October 25, 2016, included an escalating multimodal pain management, a standardized nursing assessment with interventions, and an atelectasis and mucus clearance regimen. Patients' characteristics and outcomes before and after the protocol were compared. Propensity score matching analysis was used to account for differences in baseline characteristics between groups. Intention-to-treat and protocol analyses were done. Outcome measures included mortality, length of stay (LOS), pulmonary complications, rapid response activations, and elevation in level of care.
Results:
There were 2393 and 1286 patients treated in the pre-protocol and post-protocol time periods, respectively. Adherence rate to the RFTP was 53.3%. Multivariate adjustment showed a significant reduction in hospital LOS by 1.4 days (95% CI 0.71 to 2.02), a significant decrease in the odds of requiring mechanical ventilation (OR 0.77, 95% CI 0.58 to 1.00) and rapid responses (OR 0.55, 95% CI 0.42 to 0.72). Comparison of the matched samples also showed a significant decrease in LOS (14.7 days vs 11.2 days, p<0.001), rapid responses (17.7% vs 12.8%, p=0.010), and mortality (10.7% vs 6.5%) in those treated using the RFTP in the post-protocol period. These findings were mostly substantiated on per-protocol analyses.
Conclusion:
The RFx protocol was associated with significant improvements in the LOS and a reduction in rapid responses required. In a severely morbid matched sample, the RFTP was also associated with reduced mortality. Multidisciplinary protocolized care of patients with RFx is associated with better outcomes.
Level Of Evidence:
Level III evidence (retrospective cohort study).
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