Outcomes

The primary outcomes were mechanical ventilator duration, ICU LOS, HLOS, development of pneumonia and diagnosis of severe ARDS. The secondary outcomes are discharge disposition and PRBC transfusion. All patients in the study population were treated similarly, regardless of SSRF status, with multimodal pain control, ventilator management and pulmonary care.

During this time frame, patients were treated by a single trauma surgery group with institutional guidelines for employing multimodal pain control and admission criteria to the ICU. Admission criteria to the ICU consisted of elderly trauma patients over the age of 65, respiratory insufficiency, inability to inspire greater than 1000 cc on incentive spirometer, mechanical ventilation, or any other concerning signs or symptoms at the discretion of the attending physician. Multimodal pain control consisted of use of scheduled Tylenol and narcotic medications as needed; these could be supplemented by scheduled gabapentin, scheduled muscle relaxants, scheduled intravenous ketorolac and/or epidural catheter analgesia. In 2017, our institution began using a low-dose lidocaine peripheral intravenous infusion for pain control in rib fracture pathological findings. The decision to pursue SSRF did not alter the patient’s pain regimen plan, as the patient was still treated according to our guidelines in both operative and non-operative groups.