Abstract
Introduction
Rib fractures are very common worldwide, particularly in the elderly due to the increased risk of fragility fractures. They are associated with significant morbidity and mortality, largely due to respiratory complications secondary to pain. For each additional fracture in the elderly, mortality increases by 19% and the risk of pneumonia by 27% . It is therefore crucial that recognition and effective analgesia is done promptly. This quality improvement project aimed to assess demographics and management of patients presenting to the Emergency Department (ED) at Weston General Hospital (WGH) with rib fractures.
Methods
Data was collected over a one-year period from 1/09/2021. A total of 199 patients were diagnosed with rib fractures and a random selection of 57 patients' data was analysed using basic statistics.
Results
The average age was 68. 93% had unilateral fractures and 59% had either one or two rib fractures. However, only 9% had severity scores recorded. Despite 29% having a pain score of 8 or more, there was no recorded analgesic prescription for 22% of patients. Of those that did receive analgesia, 33% received strong opioids.
Conclusion
Our data showed that there is scope for improvements in calculation of severity scores and analgesia, and therefore hopefully a reduction in complications. Following this data collection, new guidelines on rib fracture initial management have been produced and implemented at WGH. Going forward, we hope the new guidelines will provide a clear pathway for appropriate assessment and management for different severities of rib fractures, thus improving patient care.
Comments
Pain is underrated
I find it infuriating that patients are left in pain, particularly elderly patients, as if somehow being in pain is par for the course for being old.
I once nursed a lady with rib fractures, aged 82. The Surgical Consultant did the post take ward round and was speaking to her in, frankly, a patronising tone; as if she were some old dear who'd tripped on her slippers who needed to be scolded on trying to do things for herself. He perked up when she explained she'd fallen of her horse.