The expedited discharge of patients with multiple traumatic rib fractures is cost-effective

Dalton, Michael K.; Minarich, Michael J.; Twaddell, Kimberly J.; Hazelton, Joshua P.; Fox, Nicole

doi:10.1016/j.injury.2018.10.014

Cited by 10 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The elderly population has previously been shown to be less likely to meet the criteria for expedited discharges following traumatic rib fractures but is unlikely to be readmitted. 18 In disagreement with previous literature, older age was not found to be associated with an increased risk of readmission in this study.…”

Section: Discussioncontrasting

confidence: 99%

Hospital readmission after blunt traumatic rib fractures

Marthy

Mounsey

Ata

et al. 2022

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND:Hospital readmissions are resource intensive, associated with increased morbidity, and often used as hospital-level quality indicators. The factors that determine hospital readmission after blunt thoracic trauma have not been sufficiently defined. We sought to identify predictors of hospital readmission in patients with traumatic rib fractures. METHODS:We performed an 8-year (2011-2019) retrospective chart review of patients with traumatic rib fractures who required unplanned readmission within 30 days of discharge at a Level 1 trauma center. Patient characteristics, injury severity, and hospital complications were examined using quantitative analysis to identify readmission risk factors. RESULTS:There were 13,046 trauma admissions during the study period. The traumatic rib fracture cohort consisted of 3,720 patients. The cohort included 206 patients who were readmitted within 30 days of discharge. The mean age of the traumatic rib fracture cohort was 57 years, with a 6-day median length of stay. The 30-day mortality rate was 5%. Use of anticoagulation (11.0 vs. 5.4; p = 0.029), diagnosis of a psychiatric disorder (10.2 vs. 5.3; p = 0.01), active smoking (7.3 vs. 5.0; p = 0.008), associated hemothorax (8.3 vs. 5.2; p = 0.010), higher abdominal Abbreviated Injury Scale (33.3 vs. 8.4 vs. 6.5; p = 0.002), rapid response activation (8.9 vs. 5.2; p = 0.005), admission to intensive care unit (7.7 vs. 4.5; p = 0.001), and diagnosis of in-hospital pneumonia (10.1 vs. 5.4; p = 0.022) were predictors of hospital readmission. On multivariate analysis, prescribed anticoagulation (odds ratio [OR], 2.22; p = 0.033), active smoking (OR, 1.58; p = 0.004), higher abdominal Abbreviated Injury Scale (OR, 1.50; p = 0.054), and diagnosis of a psychiatric disorder (OR, 2.00; p = 0.016) predicted hospital readmission. CONCLUSION:In patients with traumatic rib fractures, those with anticoagulant use, those who actively smoke, those with a psychiatric diagnosis, or those with associated abdominal injuries are at the highest risk of rehospitalization following discharge. Quality improvement should focus on strategies and protocols directed toward these groups to reduce nonelective readmissions.

show abstract

Section: Discussioncontrasting

confidence: 99%

Hospital readmission after blunt traumatic rib fractures

Marthy

Mounsey

Ata

et al. 2022

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Increased morbidity and mortality risk in the elderly was also demonstrated in comparison to younger patients with similar injuries following rib fractures (Bulger et al 2000 ). Dalton et al ( 2019 ) concluded that increased age was the only variable predicting with statistical significance, failure to achieve expedited discharge in those having sustained multiple traumatic rib fractures. Consequently, as LOS in the elderly is influenced by many factors and not only the management implemented, this may account for the overall nonsignificant difference observed for LOS on meta-analysis (which included a predominantly older population) in our review.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, although results were considered statistically insignificant for this outcome, a possible reduction in LOS by 1 day may be of clinical and financial significance both for the patient and hospital, especially in countries where these resources are limited (Weinberg 2020 ). In a study exploring the effects of expedited discharge of patients with multiple traumatic rib fractures relative to cost-effectiveness, results demonstrated average costs of hospitalisation for those who achieved expedited discharge were less than half of the average cost for those who did not (Dalton et al 2019 ). Additional benefits from rapid discharge for patients included reduced risk of acquiring nosocomial infections and earlier return to their normal activities.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of nonpharmacological therapeutic interventions on pain and physical function in adults with rib fractures during acute care: A systematic review and meta-analysis

Weinberg

Roos

Aswegen

2022

South African Journal of Physiotherapy

View full text Add to dashboard Cite

Background: Rib fractures are a common thoracic injury and notable source of chest pain. Chest pain may lead to compromised respiratory and physical function.Objectives: Our study aimed to synthesise the evidence on the effectiveness of nonpharmacological therapeutic interventions on pain and physical function in adults admitted with rib fractures to acute care settings. Secondary outcomes included length of stay (LOS), respiratory complications, respiratory function and mortality rate.Method: A systematic literature search of English articles in nine databases was conducted. The Joanna Briggs Institute’s System for the Unified Management, Assessment and Review of Information (SUMARI) was used to conduct our study. Articles written from January 2000 to December 2017 were considered and a search update was completed in 2021. Meta-analysis was conducted for pre- versus post-bundle of care implementation for LOS, pneumonia incidence and mortality rate. Certainty of evidence was appraised using the grading of recommendations, assessment, development and evaluation (GRADE) approach.Results: Sixteen studies were included (n = 2034). Certain interventions were shown to improve respiratory function and reduce pain, pulmonary complications, LOS and mortality rate. No interventions were identified which objectively improved physical function. Meta-analysis showed a statistically significant reduction in relative risk of developing pneumonia (p = 0.00) by 63% following bundled care implementation. Certainty of evidence for this outcome was rated as very low following GRADE appraisal.Conclusion: Nonpharmacological therapeutic interventions used in combination with pharmacological management are viable treatment options to reduce pain, improve respiratory function and reduce the incidence of respiratory complications following acute rib fractures.Clinical implications: Acupuncture, transcutaneous electrical nerve stimulation (TENS), noninvasive ventilation (NIV) modalities, physiotherapy techniques and multidisciplinary pathways used alongside pharmacological interventions are effective modalities for use in the treatment of acute rib fractures. Multidisciplinary care pathways are important management strategies and reduce the risk of developing pneumonia.

show abstract

“…There was substantial variation in the content and purpose of the patient pathways identified within the included studies. Examples of this variation include differences in pathways focusing on ICU escalation or admission criteria, [2][3][4][5] analgesia and pain assessment, [3][4][5][6][7] and respiratory care and assessment. [3][4][5][6] The heterogeneity of the intervention content and purpose has overall limited the ability to integrate findings and make inference.…”

Section: Commentsmentioning

confidence: 99%

What is the optimal care pathway for patients with blunt chest wall trauma presenting to the ED?

Baker

Battle

2023

Trauma

View full text Add to dashboard Cite

Three-part question[In adults with blunt chest wall trauma presenting to the ED], what is the [optimal care pathway] for [days alive and out of hospital, quality of life at 6 months and patient reported experience]? Clinical scenarioA 54-year-old man attends your department having fallen off a two-step ladder on to a wooden chair. On their arrival the patient is complaining of right-sided chest pain. His vital signs are normal and there is no evidence of respiratory distress. On examination the patient is tender over rib 4, 5 and 6 on the right side but no further abnormality is identified but the patient has high levels of pain in the department despite receiving analgesics. There are many components to the patient's care that are required (e.g., analgesia, imaging, risk stratification, physiotherapy, ED discharge location) and these can be delivered using a formal care pathway. The optimal care pathway for managing patients with blunt chest trauma is yet to be determined. Search strategySearch strategies were developed by combining free-text and index term searching. A structured literature search was conducted (revised search: 25th May 2022) through the database Medline (Ovid) broadly following a previously published evidence review. 1 The following search strategy was used for all electronic databases with * denoting specific MeSH terms used in the review search strategy:

show abstract

The expedited discharge of patients with multiple traumatic rib fractures is cost-effective

Cited by 10 publications

References 19 publications

Hospital readmission after blunt traumatic rib fractures

Hospital readmission after blunt traumatic rib fractures

Effectiveness of nonpharmacological therapeutic interventions on pain and physical function in adults with rib fractures during acute care: A systematic review and meta-analysis

What is the optimal care pathway for patients with blunt chest wall trauma presenting to the ED?

Contact Info

Product

Resources

About