Patient-reported outcomes 6 to 12 months after isolated rib fractures: A nontrivial injury pattern

Abstract

BACKGROUND:Despite the ubiquity of rib fractures in patients with blunt chest trauma, long-term outcomes for patients with this injury pattern are not well described. METHODS:The Functional Outcomes and Recovery after Trauma Emergencies (FORTE) project has established a multicenter prospective registry with 6-to 12-month follow-up for trauma patients treated at participating centers. We combined the FORTE registry with a detailed retrospective chart review investigating admission variables and injury characteristics. All trauma survivors with complete FORTE data and isolated chest trauma (Abbreviated Injury Scale score of ≤1 in all other regions) with rib fractures were included.Outcomes included chronic pain, limitation in activities of daily living, physical limitations, exercise limitations, return to work, and both inpatient and discharge pain control modalities. Multivariable logistic regression models were built for each outcome using clinically relevant demographic and injury characteristic univariate predictors. RESULTS:We identified 279 patients with isolated rib fractures. The median age of the cohort was 68 years (interquartile range, 56-78 years), 59% were male, and 84% were White. Functional and quality of life limitations were common among survivors of isolated rib fractures even 6 to 12 months after injury. Forty-three percent of patients without a preexisting pain disorder reported new daily pain, and new chronic pain was associated with low resilience. Limitations in physical functioning and exercise capacity were reported in 56% and 51% of patients, respectively. Of those working preinjury, 28% had not returned to work. New limitations in activities of daily living were reported in 29% of patients older than 65 years. Older age, higher number of rib fractures, and intensive care unit admission were independently associated with higher odds of receiving regional anesthesia. Receiving a regional nerve block did not have a statistically significant association with any patient-reported outcome measures. CONCLUSION:Isolated rib fractures are a nontrivial trauma burden associated with functional impairment and chronic pain even 6 to 12 months after injury.

Regional anesthesia and analgesia for trauma: an updated review

“…Rib fractures are the most common injury associated with blunt chest trauma resulting in severe pain and failed respiratory mechanics [3,18]. Poorly treated pain can result in shallow tidal breathing and splinting causing atelectasis and delayed pulmonary processes such as pneumonia and acute respiratory distress syndrome [3,19,20,21]. In addition, emerging evidences suggests that rib fractures are associated with chronic pain, disability, and impaired quality of life beyond the injury [20,22,23].…”

“…Poorly treated pain can result in shallow tidal breathing and splinting causing atelectasis and delayed pulmonary processes such as pneumonia and acute respiratory distress syndrome [3,19,20,21]. In addition, emerging evidences suggests that rib fractures are associated with chronic pain, disability, and impaired quality of life beyond the injury [20,22,23]. Effective analgesia for patients with rib fractures is the primary management goal [3].…”

Additional Outcomes and Limitations in the Treatment of Acute Unstable Chest Wall Injuries

“…Although ventilator-free days, mortality, and both hospital and intensive-care-unit length of stay are important outcomes for patients with rib fractures, they are not the only outcomes that matter and may not occur with high enough frequency in patients without flail chest injuries to render meaningful comparisons . Rather, we believe chronic pain, pleural space complications, disability, and other patient-reported outcomes are more relevant . According to Supplement 8 in the original article, these outcomes were captured but absent from analyses.…”