Outcomes in patients with rib fractures following implementation of the RIB-IMPROVE rib fracture guideline.

Abstract

Aim: A rib fracture guideline was implemented at Whangārei Hospital with the aim of improving the care of patients and mitigating the risk of preventable additional morbidity. The aim of this study was to assess the impact of this guideline on the management and outcomes of patients.

Methods: A single centre retrospective audit was performed comparing patients with rib fractures pre and post the implementation of the RIB-IMPROVE guideline. The primary outcome of interest was pneumonia. Patients with an abbreviated injury score (AIS) head or abdomen >2 were excluded. Binomial logistic regression was conducted for the primary outcome with adjustments for clinically plausible variables.

Results: There were 418 patients identified, 241 in the pre-guideline and 177 in the post-guideline group. There was no difference in age, sex, ethnicity, number of rib fractures, injury severity score (ISS) or local anaesthetic block placement. The pneumonia rate was 13% vs 7% comparing the pre- and post-guideline groups, respectively. After adjustment for age, sex and ISS, the relative risk of developing pneumonia was 0.52 comparing the post- with the pre-guideline group (p=0.04). No statistical difference in secondary outcomes was seen, including the length of stay, 30-day readmission rate or 30-day mortality rate.

Conclusion: This study found that the risk of pneumonia was decreased by almost half after implementation of the RIB-IMPROVE guideline at Whangārei Hospital. This study highlights the effectiveness of a multidisciplinary guideline in the management of patients with rib fractures.