A clinical practice guideline using percentage of predicted forced vital capacity improves resource allocation for rib fracture patients

Abstract

BACKGROUND:Predicting rib fracture patients that will require higher-level care is a challenge during patient triage. Percentage of predicted forced vital capacity (FVC%) incorporates patient-specific factors to customize the measurements to each patient. A single institution transitioned from a clinical practice guideline (CPG) using absolute forced vital capacity (FVC) to one using FVC% to improve triage of rib fracture patients. This study compares the outcomes of patients before and after the CPG change. METHODS:A review of rib fracture patients was performed over a 3-year retrospective period (RETRO) and 1-year prospective period (PRO). RETRO patients were triaged by absolute FVC. Percentage of predicted FVC was used to triage PRO patients. Demographics, mechanism, Injury Severity Score, chest Abbreviated Injury Scale score, number of rib fractures, tube thoracostomy, intubation, admission to intensive care unit (ICU), transfer to ICU, hospital length of stay (LOS), ICU LOS, and mortality data were compared. A multivariable model was constructed to perform adjusted analysis for LOS. RESULTS: There were 588 patients eligible for the study, with 269 RETRO and 319 PRO patients. No significant differences in age, gender, or injury details were identified. Fewer tube thoracostomy were performed in PRO patients. Rates of intubation, admission to ICU, and mortality were similar. The PRO cohort had fewer ICU transfers and shorter LOS and ICU LOS. Multivariable logistic regression identified a 78% reduction in odds of ICU transfer among PRO patients. Adjusted analysis with multiple linear regression showed LOS was decreased 1.28 days by being a PRO patient in the study (B = −1.44; p < 0.001) with R2 = 0.198. CONCLUSION:Percentage of predicted FVC better stratified rib fracture patients leading to a decrease in transfers to the ICU, ICU LOS, and hospital LOS. By incorporating patient-specific factors into the triage decision, the new CPG optimized triage and decreased resource utilization over the study period.

Correlação entre a força muscular respiratória e a força muscular periférica dos pacientes com drenagem torácica fechada

“…Pain management improves vital capacity, chest expansion and inspiratory capacity. This implies a shorter hospital stay and more efficiency in performing breathing exercises and mobilization [7,33].…”

Morbidity and Mortality After Rib Fracture in Elderly Patients (>65 Years Old) Compared to a Younger Cohort (≤65 Years of Age) at Doctor Hospital Renaissance Health

“…Brandon et al [38] reported that RibScore, a radiographic score based on fracture pattern which includes six variables (namely ≥ 6 rib fractures, bilateral fractures, flail chest, ≥ 3 severely displaced fractures, first rib fracture, and at least one fracture in anterior, lateral, and posterior areas), was associated with complications and adverse pulmonary outcomes. More recently, Billings et al [39] and Khan et al [40] showed that rib fracture patients triaged based on forced vital capacity had shorter ICU-LOS and HLOS with 78% lower odds of ICU transfer.…”

The Effect of Frailty in Predicting Outcomes of Rib Fractures Among Elderly Patients

“…Our institution uses a prospectively validated clinical practice guideline (CPG) utilizing percent of predicted forced vital capacity (FVC%) to determine level of care for trauma patients with rib fractures. [10][11][12] We sought to compare frailty metrics with FVC% in predicting adverse outcomes. We hypothesized that frailty metrics will be more predictive of adverse outcomes than FVC% and improve triage of geriatric patients with rib fractures.…”