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Creating a Chest Wall Injury and Reconstructive program: A single center experience with rib fractures

Published:September 24, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.043

      Highlights

      • Complex rib fracture patients have improved outcomes if admitted to a center with a dedicated rib fracture program.
      • Rib fracture programs can be quickly implemented into trauma centers.
      • All level one trauma programs should have a dedicated rib fracture management program.

      Abstract

      Background

      New Chest Wall Injury and Reconstructive Centers (CWIRC) are emerging; this study aims to investigate the potential benefits of implementing a CWIRC at a single institution. We hypothesized that patients treated at CWIRC will have improved outcomes.

      Methods

      We instituted a CWIRC in 2019 at our American College of Surgeons (ACS) Level One Trauma Center. We retrospectively compared trauma patients with rib fractures who presented to our center 18 months before (PRE-C) and 18 months after CWIRC implementation (POST-C). Outcomes measured included mortality, length of stay (LOS), intensive care unit (ICU-LOS), readmission rates, and unplanned ICU admission.

      Results

      There were 192 PRE-C patients, compared to 388 POST-C. The mortality in PRE-C was not significantly different compared to the POST-C group (11.46% vs 8.8%, p=0.308). There were also no differences in LOS, ICU-LOS, readmission, and unplanned ICU admission. ICU utilization was dramatically different: PRE-C 17.8% were admitted to ICU compared to 35.6% POST-C (p<0.0001).

      Conclusions

      The number of patients admitted with rib fractures to our center nearly doubled after CWIRC establishment. Early diagnosis and triage led to significantly more admissions to higher levels of care. There are trends toward improved outcomes using practice management protocols, albeit with higher ICU utilization. Establishment of a CWIRC should be considered for level 1 ACS trauma centers and as utilization of established CWIRC protocols are increased, patients will have improved outcomes.

      Level of Evidence

      IV

      Study Type

      Retrospective chart review.

      Keywords

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