Yeh Kevin, Spence Nicole, Beaulieu-Jones Brendin R, Taylor Michael, Jhaveri Ansel, Centola Kathleen, Charise Tricia, Orf Janet, Richman Aaron
Department of Pharmacy, Boston University Medical Center, Boston, MA, USA.
Department of Anesthesiology, Boston University Medical Center, Boston, MA, USA.
Surg Pract Sci. 2023 Jun 15;14:100192. doi: 10.1016/j.sipas.2023.100192. eCollection 2023 Sep.
Traumatic rib fractures are associated with increased morbidity and mortality, with complications including pneumothorax, difficult to control pain, and pneumonia. Use of a bundled, multi-disciplinary approach to the care of patients with multiple rib fractures has been shown to reduce morbidity and mortality. In this study, we investigate the implementation of a checklist for the multidisciplinary management of patients with multiple rib fractures who present to an urban, level 1 trauma center and safety-net hospital.
This was a single-institution, retrospective cohort study to assess changes in treatment characteristics and patient outcomes before and after implementation of a comprehensive checklist for the management of high-risk patients with three or more traumatic rib fractures at a level-one trauma center. The primary outcome was pneumonia rates with secondary outcomes of mechanical ventilation rates and mechanical ventilation days, ICU length of stay, mortality, and non-opioid and opioid consumption (morphine milligram equivalents).
A total of 104 patients met study eligibility, including 51 patients who presented during the pre-protocol period and 53 patients who received care after implementation. We observed that the checklist was utilized and reviewed in 83% of patients during the post-protocol period. Pneumonia rates were significantly lower in the post-protocol group (35.3% vs 15.1%, = 0.017). There was no difference in the number of patients who required mechanical ventilation or the duration of mechanical ventilation. On unadjusted analysis, median overall length of stay (11.5 days vs 13 days, = 0.71), median ICU stay (4 days vs 5 days, = 0.18), and rate of in-hospital mortality (11.8% vs 7.6%, = 0.47) was not different between the two time periods.
In patients with chest wall trauma and associated rib fractures, implementation of a standardized, multidisciplinary checklist to ensure utilization of multimodal analgesia and non-pharmacological interventions was associated with decreased pneumonia rates at our institution.
创伤性肋骨骨折与发病率和死亡率的增加相关，其并发症包括气胸、难以控制的疼痛和肺炎。已证明采用综合多学科方法治疗多根肋骨骨折患者可降低发病率和死亡率。在本研究中，我们调查了一份针对就诊于城市一级创伤中心和安全网医院的多根肋骨骨折患者进行多学科管理的检查表的实施情况。
这是一项单机构回顾性队列研究，旨在评估在一级创伤中心实施针对有三根或更多创伤性肋骨骨折的高危患者的综合管理检查表前后治疗特征和患者预后的变化。主要结局是肺炎发生率，次要结局包括机械通气率、机械通气天数、重症监护病房（ICU）住院时间、死亡率以及非阿片类和阿片类药物消耗量（吗啡毫克当量）。
共有104例患者符合研究纳入标准，其中51例患者在方案实施前就诊，53例患者在实施后接受治疗。我们观察到在方案实施后的时期，83%的患者使用并审查了检查表。方案实施后组的肺炎发生率显著降低（35.3%对15.1%，P = 0.017）。需要机械通气的患者数量或机械通气持续时间没有差异。未经调整的分析显示，两个时间段之间的中位总住院时间（11.5天对13天，P = 0.71）、中位ICU住院时间（4天对5天，P = 0.18）和院内死亡率（11.8%对7.6%，P = 0.47）没有差异。
在胸壁创伤及相关肋骨骨折患者中，实施标准化的多学科检查表以确保多模式镇痛和非药物干预的使用与我院肺炎发生率降低相关。
