(1545) A Standardized Approach to Traumatic Rib Fractures Leads to Decreased Intubation Rates and ICU LOS

Introduction: Patients with traumatic rib fractures are at increased risk for multiple complications including pneumonia, ARDS, and increased rates of intubation. In 2014, a standardized algorithm for the management and triage of patients with traumatic rib fractures was developed by Wellspan York Hospital, which addressed the importance of early analgesia and aggressive care in the management of rib fractures. The purpose of our study was to examine how the implementation of a standardized PIC (pain, inspiration and cough) protocol affected unplanned ICU admissions, rates of intubations, and ICU length-of-stay (LOS) at our institution.

Methods: A retrospective review of patients presenting to our institution with traumatic rib fractures was reviewed between 2018-2022, with inclusion of 820 patients. Our protocol involved measuring a patient’s pain level, assessing maximal volume during inspiration, as measured by the use of an incentive spirometer, and assessing cough strength, along with a multimodal pain regimen and early mobilization. Patients were given a PIC score, with patients scoring < 5 being admitted to the ICU. Information was collected on patients’ demographics, pain regimen provided, overall LOS, ICU LOS, unplanned ICU admissions, and rates of intubations.

Results: Our results show that implementation of the PIC protocol dramatically reduced the rates of intubation in patients with traumatic rib fractures (18.2% vs 3.0%, p < 0.001), regardless of patients’ age, gender, race, or number of rib fractures. Furthermore, we also observed that patients with an Injury Severity Score (ISS) greater than 25 were less likely to be intubated after protocol implementation, 65% vs 16%, p < 0.001). ICU LOS was also significantly decreased in younger patients (18-64 years old) after protocol implementation (p = 0.005). Our rate of unplanned respiratory-associated ICU admissions also decreased, 5.2% vs 1.5%, respectively.

Conclusions: Traumatic rib fractures are a major contributor to overall morbidity among trauma patients, which includes pulmonary complications, the need for aggressive ICU care, and ICU length of stay. Overall, with implementation of a standardized PIC protocol at our institution, we observed significantly decreased rates of intubations, unplanned ICU admissions, and decreased ICU LOS.