Rib fractures in Older People - a review of Practice at a District General Hospitalral

Introduction:

Optimising the management of older patients with rib fractures at a District General Hospital. 

Method: 
This retrospective quality improvement project included all patients >65 years old admitted with rib fractures over a six-month period (01/01/2025–01/07/2025). Data was collected from the electronic health record (Cerner). Data will be presented as median (range). Statistical analysis conducted on GraphPad Prism. 

Results: 

81 patients were included, aged 82 (65-100) years. Fifty patients (61%) had a clinical frailty score (CFS) The average battle score was 23, with twenty-seven (33%) patients having a battle score of >25 (Mortality risk>80%). Average length of stay (LOS) was 11 (1-60) days. Ten patients had chest drains inserted. Four patients died as a sequelae of their injuries, 2 from hospital acquired pneumonia, 1 with progression of subdural haemorrhage and 1 respiratory failure. The deceased patients were 88 (84-92) years old, with a battle score of 30 (25-34) and a CFS of 4. 

28 patients (34%) were on anticoagulation, predominantly Direct Oral Anticoagulants, one for a metallic heart valve, four for venous thromboembolism and twenty-three (82%) for atrial fibrillation.

Multimodal analgesia was used, with 93% (n=75) requiring lidocaine patches, 42%(n=34) using morphine and 75%(n=61) using oxycodone. Six patients had no opioid analgesia. Eighteen patients received rib blocks. LOS for patients receiving Lidocaine patches was 12 (0-40) days as compared to 18 (2-60) days in patients who did not have these (p=0.44). 

LOS for frail patients (CFS ≥4) was 13 (1-32) days as compared to 9 (1-60) days in patients with CFS<4 (p= 0.1003).  

Conclusion:

Frail patients experience longer LOS, but this was not statistically significant in this small cohort. Establishing a ‘Rib fracture pathway’ will optimise patient care.