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#35876 Reviewing the application of rib fracture pain management policy in a district general hospital
  1. Joby Abraham Mathew1,
  2. Woei Lin Yap2,3,
  3. Prashast Verghese4,
  4. Laura Borrowman5,
  5. Sushil Pal5 and
  6. Jennifer Dodd5
  1. 1University Of Liverpool, Liverpool, UK
  2. 2University Of Liverpool, Liverpool , UK
  3. 3Countess of Chester Hospital, University Of Liverpool, Liverpool , UK
  4. 4Health Education North West, none, Liverpool , UK
  5. 5Countess of Chester Hospital, none, Liverpool , UK


Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission

Background and Aims Rib fractures commonly occur in trauma patients and cause morbidity and mortality due to secondary pulmonary complications. This study aims to assess if patients presenting with rib fractures are managed according to the Countess of Chester hospital (COCH) rib fracture guidelines and outcomes.

Methods Data was collected on patients >18 years of age presenting to COCH with rib fractures between April 2022 and April 2023. Outcomes measured were rates of rib fracture score (RFS) calculation, regional anaesthetic (RA) block rates, LOS (length of stay), intensive treatment unit (ITU) admission rates and mortality rates.

Results A total of 48 patients were included in the study. 25% had RFS calculated during their stay. Totally, 20.83% of patients had a RA block attempted however only 30.77% of patients with an RFS > 9 had a RA block attempted. 18.75% required ITU admission – these patients had an average LOS of 10.11 days in ITU and 24.5 days overall. 83.33% were discharged home, 8.33% died and 8.33% were transferred elsewhere.

Abstract #35876 Figure 1

Graph showing outcomes of patients with different rib fracture scores

Conclusions 75% of patients presenting to COCH with rib fracture did not have a RFS calculated and therefore were not considered for RA blocks. In addition, a significant proportion of anaesthetists were untrained in nerve blocks/nerve catheters for rib fractures. We are now administering ESPB catheter training and are administering education to nursing staff to improve rates of RFS calculation and improve risk stratification of these patients. We anticipate these interventions to reduce morbidity, mortality and subsequent LOS, which we will re-audit in 1 years’ time.

Attachment ESRA Ethics letter.pdf

  • Audit
  • Regional Anaesthesia

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