S. A. Bellister1, R. D. Betzold1, S. E. Nelson1, D. P. Stonko1, R. A. Guyer1, T. J. Hamilton1, J. P. Wanderer1, O. L. Gunter1, O. D. Guillamondegui1, B. M. Dennis1 1Vanderbilt University Medical Center,Division Of Trauma And Surgical Critical Care,Nashville, TN, USA
Introduction: Rib fractures are a source of significant morbidity. Inadequate pain
control compromises respiratory function which can lead to respiratory complications and
adverse outcomes. A dedicated pain management service provides expertise in
multimodal pain management techniques which may mitigate these events. We sought to
assess the effect of a comprehensive pain service (CPS) on the outcomes of patients with
rib fractures.
Methods: A retrospective analysis on all adult patients (age ≥ 16) with more than 2 rib
fractures at a level 1 trauma center from September 2010 through December 2015 was
executed. 1:1 propensity matching was performed on the likelihood of receiving a CPS
consult. Demographic, injury data and medication use were examined. The primary
outcome was in-hospital mortality, secondary outcomes included pneumonia,
tracheostomy, 30-day ventilator-free days and 30-day ICU-free days. Mortality,
pneumonia and tracheostomy were analyzed using logistic regression, while 30-day
ventilator-free days and 30-day ICU-free days required proportional odds ordinal logistic
regression.
Results: 3,215 patients that met inclusion criteria, with a final matched cohort of 1,022
patients receiving CPS consults and 1,022 without consult. Demographics (mean age)
and injury (ISS and rib fractures) were similar in both groups. CPS consult was associated
with decreased mortality (OR 0.52, 95% CI 0.30-0.88). CPS consultation was associated
with decreased pneumonia (OR 0.58, 95% CI 0.37-0.89), tracheostomy (OR 0.54, 95%
CI 0.36-0.81), and 30-day ICU-free days (OR 0.68, 95% CI 0.58-0.80). There was
increase in 30-day ventilator-free days (OR 1.28, 95% CI 1.03-1.60) with CPS consult.
Conclusion: A comprehensive pain service consultation in rib fracture patients is
associated with a nearly 50% reduction in mortality, as well as reductions in pneumonia
and tracheostomy rates. There also is an increase in ventilator-free days in patients with
CPS consults.