(1549) Guideline Adherence Improves Rib Fracture Patient Outcomes

Introduction: Rib fractures often lead to significant morbidity and mortality, especially among older adults. Optimal pain management and appropriate patient disposition can notably improve patient outcomes. This study aimed to evaluate the outcomes of patients with rib fractures where a standardized guideline incorporating the Pain Intensity and Communication (PIC) score was adhered to versus those where it was not applied.

Methods: The guideline, implemented on March 1, 2022, used the PIC score to evaluate patient pain levels and the necessity for epidural analgesia. The guideline further assisted in deciding the optimal level of care for Emergency Department (ED) disposition (ICU versus floor) considering age, comorbidity load, injury severity and initial physiologic responses. We retrospectively analyzed outcomes for patients admitted with rib fractures where the guideline was adhered to and those where the guideline was not used over the same period. The primary outcomes were hospital events and complications, which included unplanned intubation, ICU admission, respiratory code, pneumonia, PE, DVT and death.

Results: In our study of 442 admitted patients, adherence to the guideline significantly reduced hospital events (p < 0.01). Early epidural utilization, non-invasive mechanical ventilation, incentive spirometry use beginning at time of admission and structured pain control regimens were more prevalent in the intervention group compared to their rescue usage in non-adherence instances. The average age of all participants was 55 years. Adherent group average age was 60 years and that of the non-adherent group was 54 years. The non-adherent population made up 49.7% of participating patients. Total number of complications identified was 42 and 87.9% of these complications occurred in the non-adherent group.

Conclusions: Guideline adherence, including the use of the PIC score for pain management and optimal ED disposition, led to more accurate patient assignments and decreased ICU overuse. It also significantly reduced the incidence of in-hospital events and complications, markedly improving outcomes for those with rib fractures. The substantial benefits indicate the necessity for more widespread implementation of structured guidelines in rib fracture management.