Battle Audit: Rib Fracture Management in Older Adults living with Frailty in a Secondary Care Setting

Introduction

The Battle score is a validated risk stratification model for traumatic rib fracture presentations to secondary care. When combined with the Clinical Frailty Score (CFS), it aids identification of older patients living with frailty with increased risk of rib fracture complications. Multimodal analgesia is central to rib fracture management. NICE guidance states Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) should not be prescribed for these patients.

The audit aimed to determine whether Rib Fracture Risk Stratification Scores (RFRSS) were used, if appropriate analgesia was prescribed and if high-risk patients underwent Anaesthetist Assessment within 48 hours (AA48).

Method

We included patients admitted to a district general hospital with traumatic rib fractures who received a comprehensive geriatric review between 01/09/25-31/10/25.

Records were reviewed retrospectively and data recorded including age, CFS and/or RFRSS documentation on admission, NSAID prescription, if underwent AA48, rib fracture complications and mortality.

We retrospectively calculated Battle scores and CFS using admission documentation.

Results

Twenty-eight patients were identified: their average age was 86.6 years (SD±6.83) and retrospectively calculated average CFS was 4.5 (SD±1.8).

No patients had a documented RFRSS, 39.3% (11/28) were prescribed NSAIDs and 21.4% (6/28) underwent AA48.  

Ten patients (37.5%) developed rib fracture complications and 20% (2/10) of these underwent AA48.

The retrospectively calculated average Battle score was 28.4 for those with rib fracture complications and 23.8 for those without complications. For the 14.3% (4/28) who died during admission it was 31 compared to 25.5 for survivors. When analysed with two-sample t-tests with unequal variances, both differences were not statistically significant.

Conclusions

RFRSS were not documented for older patients living with frailty with traumatic rib fractures. Current local guidance results in the minority of high-risk patients receiving AA48, increasing morbidity risk. New guidance should advocate for routine risk stratification.