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 journalArticlepeer-review

96 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Surgery

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