Background and Aims In 2018, we implemented a multidisciplinary chest trauma pathway, which includes a validated scoring system to identify patients at high risk of morbidity and mortality1, and a suggested analgesic plan including the use of regional anaesthesia, predominantly recommending erector spinae catheters.
We performed a retrospective study of the utilisation of regional anaesthesia in patients at high risk of morbidity and mortality in 2017. The chest trauma pathway was then introduced and data was collected prospectively thereafter. We analysed data for 2018, 2019 and 2021 to examine potential improvement and whether it was sustained over time. Data was not collected for 2020 due to covid-19.
Methods Retrospective and prospective data analysis for patients with chest trauma scores >21 (high risk), and >31 (very high risk) before and after the introduction of the chest trauma pathway.
Results We identified a total of 115 patients with a chest trauma score of >21 and 58 with a score of >31. In 2017, regional anaesthesia was used in 45% (n=5) of patients with a score >21 and 28% (n=2) with a score >31. This rose to 57% (n=11) and 87% (n=7) respectively in 2018, 58% (n=17) and 76% (n=10) in 2019, and 63% (n=82) and 81% (n=39) in 2021 (see table 1).
Conclusions Over time, our study shows that a dedicated chest trauma pathway not only identifies more patients admitted to hospital with significant rib fractures at high risk of complications, but through enhanced multi-disciplinary care, consistently improves access to simple regional anaesthetic techniques such as erector spinae catheters.