A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients

S. Rob Todd, Michael M. McNally, John B. Holcomb, Rosemary A. Kozar, Lillian S. Kao, Ernest A. Gonzalez, Christine S Cocanour, Gary A. Vercruysse, Marjorie H. Lygas, Bobbie K. Brasseaux, Frederick A. Moore

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Background: We initiated a multidisciplinary clinical pathway targeting patients greater than 45 years of age with more than 4 rib fractures. The purpose of the current study was to evaluate the effect of this pathway on infectious morbidity and mortality. Methods: This was a prospective cohort study. Data evaluated included patient demographics, injury characteristics, pain management details, lengths of stay, morbidity, and mortality. Univariate and multivariate analyses were performed using a significance level of P < .05. Results: When adjusting for age, injury severity score, and number of rib fractures, the clinical pathway was associated with decreased intensive care unit length of stay by 2.4 days (95% confidence interval [CI] -4.3, -0.52 days, P = .01) hospital length of stay by 3.7 days (95% CI -7.1, -0.42 days, P = .02), pneumonias (odds ratio [OR] 0.12, 95% CI 0.04 to 0.34, P < .001), and mortality (OR 0.37, 95% CI 0.13 to 1.03, P = .06). Conclusions: Implementation of a rib fracture multidisciplinary clinical pathway decreased mechanical ventilator-dependent days, lengths of stay, infectious morbidity, and mortality.

Original languageEnglish (US)
Pages (from-to)806-811
Number of pages6
JournalAmerican Journal of Surgery
Volume192
Issue number6
DOIs
StatePublished - Dec 2006

Fingerprint

Rib Fractures
Critical Pathways
Length of Stay
Morbidity
Mortality
Confidence Intervals
Wounds and Injuries
Odds Ratio
Injury Severity Score
Mechanical Ventilators
Pain Management
Intensive Care Units
Pneumonia
Cohort Studies
Multivariate Analysis
Demography
Prospective Studies

Keywords

  • Mortality
  • Multidisciplinary clinical pathway
  • Pain management
  • Pneumonia
  • Rib fractures

ASJC Scopus subject areas

  • Surgery

Cite this

A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. / Todd, S. Rob; McNally, Michael M.; Holcomb, John B.; Kozar, Rosemary A.; Kao, Lillian S.; Gonzalez, Ernest A.; Cocanour, Christine S; Vercruysse, Gary A.; Lygas, Marjorie H.; Brasseaux, Bobbie K.; Moore, Frederick A.

In: American Journal of Surgery, Vol. 192, No. 6, 12.2006, p. 806-811.

Research output: Contribution to journalArticle

Todd, SR, McNally, MM, Holcomb, JB, Kozar, RA, Kao, LS, Gonzalez, EA, Cocanour, CS, Vercruysse, GA, Lygas, MH, Brasseaux, BK & Moore, FA 2006, 'A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients', American Journal of Surgery, vol. 192, no. 6, pp. 806-811. https://doi.org/10.1016/j.amjsurg.2006.08.048
Todd, S. Rob ; McNally, Michael M. ; Holcomb, John B. ; Kozar, Rosemary A. ; Kao, Lillian S. ; Gonzalez, Ernest A. ; Cocanour, Christine S ; Vercruysse, Gary A. ; Lygas, Marjorie H. ; Brasseaux, Bobbie K. ; Moore, Frederick A. / A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. In: American Journal of Surgery. 2006 ; Vol. 192, No. 6. pp. 806-811.
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