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Acute pain consult and management is associated with improved mortality in rib fracture patients
  1. Katherine D Sborov1,
  2. Bradley M Dennis2,
  3. Getúlio Rodrigues de Oliveira Filho3,
  4. Seth A Bellister4,
  5. Nicholas Statzer5,
  6. David P Stonko6,
  7. Richard A Guyer7,
  8. Jonathan P Wanderer5,
  9. Robel T Beyene2,
  10. Matthew D McEvoy5 and
  11. Brian Frazer Scott Allen5
  1. 1Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  2. 2Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  3. 3Department of Surgery, Federal University, Florianopolis, Santa Catarina, Brazil
  4. 4Department of Acute Care Surgery, CHRISTUS Trinity Mother Frances Health System, Tyler, Texas, USA
  5. 5Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  6. 6Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
  7. 7Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Katherine D Sborov, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; katiesborov{at}comcast.net

Abstract

Introduction Traumatic rib fractures result in significant patient morbidity and mortality, which increases with patient age and number of rib fractures. A dedicated acute pain service (APS) providing expertize in multimodal pain management may reduce these risks and improve outcomes. We aimed to test the hypothesis that protocolized APS consultation decreases mortality and morbidity in traumatic rib fracture patients.

Methods This is a retrospective observational, propensity-matched cohort study of adult patients with trauma with rib fractures from 2012 to 2015, at a single, large level 1 trauma center corresponding to introduction and incorporation of APS consultation into the institutional rib fracture pathway. Using electronic medical records and trauma registry data, we identified adult patients presenting with traumatic rib fractures. Patients with hospital length of stay (LOS) ≥2 days were split into two cohorts based on presence of APS consult using 1:1 propensity matching of age, gender, comorbidities and injury severity. The primary outcome was difference in hospital mortality. Secondary outcomes included LOS and pulmonary morbidity.

Results 2486 patients were identified, with a final matched cohort of 621 patients receiving APS consult and 621 control patients. The mortality rate was 1.8% among consult patients and 6.6% among control patients (adjusted OR 0.25, 95% CI 0.13 to 0.50; p=0.001). The average treatment effect of consult on mortality was 4.8% (95% CI 1.2% to 8.5%;. p<0.001). APS consultation was associated with increased intensive care unit (ICU) LOS (1.19 day; 95% CI 0.48 to 1.90; p=0.001) and hospital LOS (1.61 days; 95% CI 0.81 to 2.41 days; p<0.001). No difference in pulmonary complications was observed.

Discussion An APS consult in rib fracture patients is associated with decreased mortality and no difference in pulmonary complications yet increased ICU and hospital LOS.

  • critical care
  • pain management
  • injections, spinal
  • analgesia
  • acute pain

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Footnotes

  • Contributors KDS: study conceptualization and design, methodology, data collection, writing of original draft, review and editing of final manuscript, approved of the final version of the manuscript. BMD: study conceptualization and design, methodology, data collection, writing of original draft, review and editing of final manuscript, approved of the final version of the manuscript. GRdOF: study conceptualization and design, methodology, data analysis, review and editing of final manuscript, approved of the final version of the manuscript. SAB: study conceptualization and design, methodology, data collection, approved of the final version of the manuscript. NS: study conceptualization and design, methodology, review and editing of final manuscript, approved of the final version of the manuscript. DPS: study conceptualization and design, methodology, data collection, approved of the final version of the manuscript. RAG: study conceptualization and design, methodology, data collection, approved of the final version of the manuscript. JPW: study conceptualization and design, methodology, data collection, approved of the final version of the manuscript. RTB: study conceptualization and design, methodology, review and editing of final manuscript, approved of the final version of the manuscript. MDM: study conceptualization and design, methodology, writing of original draft, review and editing of final manuscript, approved of the final version of the manuscript. BFSA: guarantor, study conceptualization and design, methodology, data collection, writing of original draft, review and editing of final manuscript, approved of the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.