You are here

Article Text

Article menu

Download PDFPDF

Original Article
Emergency department management of patients with rib fracture based on a clinical practice guideline
  1. Chase Hamilton1,
  2. Lauren Barnett2,
  3. Allison Trop2,
  4. Brian Leininger3,
  5. Adam Olson1,
  6. Aaron Brooks1,
  7. Daniel Clark1,
  8. Thomas Schroeppel3
  1. 1Rocky Vista University, Parker, Colorado, USA
  2. 2Department of Emergency Medicine, University of Colorado Health-South, Memorial Hospital, Colorado Springs, Colorado, USA
  3. 3Department of Trauma and Acute Care Surgery, University of Colorado Health-South, Memorial Hospital, Colorado Springs, Colorado, USA
  1. Correspondence to Dr Thomas Schroeppel, Department of Trauma and Acute Care Surgery, University of Colorado Health-South, Memorial Hospital, Colorado Springs, CO 80909, USA; thomas.schroeppel{at}uchealth.org

Abstract

Background Clinical practice guidelines (CPGs) have the ability to increase efficiency and standardize care. A CPG based on forced vital capacity (FVC) for rib fractures was developed as a tool for triage of these patients. The objectives of this study were to assess the efficacy and compliance of physicians with this rib fracture CPG.

Methods Patients >18 that were discharged from an urban level 2 trauma center emergency department (ED) between the dates of January 1, 2014, to December 31, 2016, were eligible for the study. Demographics, mechanism, outcomes and FVC were abstracted by review of the electronic medical record. Compliance with the CPG was examined, and comparisons were made between patients successfully discharged and patients who returned.

Results 455 patients met were identified during the study period. 233 were eligible after exclusions. 64% of the cohort was male with median age of 53 years. Falls were the most common mechanism (59.6%). The median number of rib fractures was 2 and median FVC 2500 mL. 28 (12.0%) of the 233 returned to the ED after discharge. The groups were well matched with no significant differences. The most common reason for return was pain (95%). Adjusted analysis showed that increasing age (adjusted OR (AOR) 0.968) and FVC (AOR 0.999) were independent predictors. Adherence with the CPG was good for hemothorax/pneumothorax and bilateral fractures (96%), but lagged with the number of fractures (74%).

Conclusions This study confirms that the rib fracture CPG is safe and an FVC of 1500 mL is a safe criterion for discharging patients with rib fractures. Interestingly, it appears that older age is protective. More work needs to be done on effective pain control to decrease return to ED visits using this CPG.

Level of evidence IV.

Type of study Therapeutic.

  • clinical practice guidelines
  • ed management
  • rib fractures

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2017-000133

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors CH, LB, AT and TS conceived the study and designed the investigation. CH, LB, AT, AO, AB and DC conducted data collection. LB and AT oversaw quality control of the data collection. TS provided statistical analysis of the collected data. CH drafted the article and all authors contributed to its revision. CH takes responsibility for the article as a whole.

    • Competing interests None declared.

    • Ethics approval The Institutional Review Board of University of Colorado Health approved the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.