J. A. Henglein1, E. Margiotta1, I. E. Wenger1, P. Boland1, N. Martella1, A. Betancourt-Ramirez1, S. F. Small1 1South Shore University Hospital, Acute Care Surgery, Bayshore, NEW YORK, USA
Introduction: Patients with rib fractures from traumatic injuries may suffer increased morbidity, an increased hospital stay, an increased length of time in the ICU, pulmonary complications resulting in the need for mechanical ventilation, and increased mortality. Some studies have focused on developing specific scoring systems to triage and to help identify patients most at risk for the most severe complications. One such protocol is the RibScore. At our institution, we use the Pain, Inspiratory Effort, Cough Score (PIC Score) to help stratify patients most likely to require ICU admission. This study compared our protocol with the previously published and validated RibScore.
Methods: This was a retrospective review of patients with traumatic rib fractures presenting to our trauma center between 2018-2022. The primary outcomes evaluated were overall length of stay (LOS) and ICU LOS, with a secondary outcome of rates of intubation. We collected basic patient demographics, and also methods to control analgesia, whether a nerve block was performed, and if the patient was mobilized. We used an initial PIC score of <5 to indicate the need for ICU admission. Statistical analysis was performed with a value of p<0.05 deemed statistically significant.
Results:We found that a PIC score <5 is associated with a significant increase in both the overall length of stay (>2 days) and the ICU LOS (1.5 days) compared to a PIC score >5 (p=0.03 and p=<0.001). It was also associated with higher rates of intubation that approached statistical significance, but was underpowered (13.6% vs 2.4%, p=-0.023). Similarly, a RibScore of 4-6 was associated with a statistically significant increase also in overall length of stay (4 days) and ICU LOS (4 days) when compared to a RibSCore of 1-3 (p=0.004 and p=<0.001), as well as a statistically significant increase in the rates of intubation (26.5% vs 9%, p= <0.001), when compared to a RibScore of 1-3.
Conclusion:Patients with rib fractures are at an increased risk of morbidity and mortality. The use of radiographic signs have been used to aid clinicians in accurately stratifying patients with traumatic rib fractures who are at increased risk. Here, we utilize two methods of stratifying patients, the previously described RibScore and our institutional PIC Score. As has been previously published, we found that a RibScore >4 is associated with significant increases in rates of intubation. We also found an increase in overall and ICU LOS; this correlates with our PIC score. Comparing the two scores, we found a percentage agreement of 88.9. One advantage of the PIC score over the RibScore is its ability to be easily and rapidly scored at the bedside upon initial patient presentation by both physicians and nurses. To our knowledge this is the first time another method of stratifying patients has been compared to the RibScore, and using the PIC score may give the clinician an opportunity to identify patients most at risk, aiding in their disposition and management.