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me to develop the critical thinking skills and vision necessary to be successful in academia and clinically. His mentorship and direction have been invaluable, and I will carry these experiences with me throughout my career.I would also like to thank Dr. Hui Zheng for his assistance with statistical analysis.He truly helped this project come to fruition, and I sincerely appreciate all of his hard work.Additionally, I would like to thank the members of the Center for Vascular Emergencies at Massachusetts General Hospital. In particular, I would like to thank Nicholas Giordano, who has been a tremendous source of support throughout my project.He has always been available with a helping hand, and I appreciate him taking his time to assist me throughout this project. I would also like to thank my fellow clinical research coordinator, Jasmine Torrey, who oriented me to our Pulmonary Embolism Response Team database and has been a friend throughout this year.Lastly, I would like to thank the students and faculty of the Boston University M.S.in Medical Sciences Program. Thank you to Dr. Carl Franzblau who has been a wonderful advisor throughout my time in this program and provided feedback on this thesis. I would also like to thank our program director, Dr. Gwynneth Offner. She put her faith in me and truly changed the trajectory of my life. I hope to make her proud as a future physician. vi

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.