Prospective validation of the Rib Injury Guidelines for traumatic rib fractures

Abstract

The Rib Injury Guidelines (RIG) were developed to guide triage of traumatic rib fracture patients to home, regular floor, or intensive care unit (ICU) and standardize care. The RIG score is based on patient history, physical examination, and imaging findings. The aim of this study was to evaluate triage effectiveness and health care resources utilization following RIG implementation. METHODS:This is a prospective analysis at a level I trauma center from October 2017 to January 2020. Adult (18 years or older) blunt trauma patients with a diagnosis of at least one rib fracture on computed tomography imaging were included. Patients before (PRE) and after (POST) implementation of RIG were compared. In the POST group, patients were divided into RIG 1, RIG 2, and RIG 3 based on their RIG score. Outcomes were readmission for RIG 1 patients, unplanned ICU admission for RIG 2 patients, and overall ICU admission. Secondary outcomes were hospital length of stay (LOS) and mortality. RESULTS: A total of 1,100 patients were identified (PRE, 754; POST, 346). Mean ± SD age was 56 ± 19 years, 788 (71.6%) were male, and median Injury Severity Score was 14 (range, 10-22). The most common mechanism of injury was motor vehicle collision (554 [50.3%]), 253 patients (22.9%) had ≥5 rib fractures, and 53 patients (4.8%) had a flail chest. In the POST group, 74 patients (21.1%) were RIG 1; 121 (35.2%), RIG 2; and 151 (43.7%), RIG 3. No patient in RIG 1 was readmitted following initial discharge, and two patients (1.6%) in RIG 2 had an unplanned ICU admission (both for alcohol withdrawal syndrome). Patients after implementation of RIG had shorter hospital LOS (3 [1-6] vs. 4 [1-7] days; p = 0.019) and no difference in mortality (5.8% vs. 7.7%; p = 0.252). On multivariate analysis, RIG implementation was associated with decreased ICU admission (adjusted odds ratio, 0.55 [0.36-0.82]; p = 0.004). CONCLUSION:Rib Injury Guidelines are safe and effectively define triage of rib fracture patients with an overall reduction in ICU admissions, shorter hospital LOS, and no readmissions.

Spezielle intensivmedizinische Behandlungskonzepte des schweren Thoraxtraumas

“…Für Rippenfrakturen stehen beispielsweise auch validierte Scoring-Systeme, wie das der "Rib Injury Guidelines" zur Verfügung, die eine Gewichtung verschiedener Risikofaktoren erlauben, um den Überwachungsbedarf zu bestimmen [17]. Hierdurch konnten die Häufigkeit einer Intensivstationären Aufnahme und die Dauer der Krankenhausbehandlung reduziert werden [17].…”

Clinical prediction models for the management of blunt chest trauma in the Emergency Department: a systematic review

“…A number of new clinical prediction models have been developed (all high risk of bias studies) but not yet validated were included in the review. These included the Tracheostomy in Thoracic Trauma Prediction Score 20 (T 3 P-Score, c-index for tracheostomy: 0.938, 95% CI: 0.920-0.956), Sequential Clinical Assessment of Respiratory Function 37 (SCARF Score, c-index for pneumonia: 0.86), Rib Injury Guidelines 46 (RIG, c-index not reported), the Lung Organ Failure Score 53 (c-index not reported), and a new scoring system 35 (c-index: 0.82; 95% CI: 0.77-0.88).…”