Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol

Cordelie E Witt, Eileen M Bulger, Cordelie E Witt, Eileen M Bulger

Abstract

Rib fractures are common among patients sustaining blunt trauma, and are markers of severe bodily and solid organ injury. They are associated with high morbidity and mortality, including multiple pulmonary complications, and can lead to chronic pain and disability. Clinical and radiographic scoring systems have been developed at several institutions to predict risk of complications. Clinical strategies to reduce morbidity have been studied, including multimodal pain management, catheter-based analgesia, pulmonary hygiene, and operative stabilization. In this article, we review risk factors for morbidity and complications, intervention strategies, and discuss experience with bundled clinical pathways for rib fractures. In addition, we introduce the multidisciplinary rib fracture management protocol used at our level I trauma center.

Keywords: morbidity and mortality; pain management; protocols; rib fractures.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Harborview Medical Center rib fracture management protocol. ICU, intensive care unit; IS, incentive spirometry; IV, intravenous; PIC, Pain, Inspiratory capacity, and Cough; PCA, patient-controlled analgesia.
Figure 2
Figure 2
Harborview Medical Center PIC scoreboard. IS, incentive spirometry; PIC, Pain, Inspiratory capacity, and Cough.

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