• Joshua D Billings, Abid D Khan, L Paige Clement, Alyssa A Douville, Eric W Brown, and Thomas J Schroeppel.
• From the Department of Trauma and Acute Care Surgery (J.D.B., A.D.K., T.J.S.), University of Colorado Health Memorial Hospital, Colorado Springs; Department of Surgery (J.D.B., A.D.K., T.J.S.), University of Colorado, Aurora; and Department of Pharmacy (L.P.C., A.A.D., E.W.B.), University of Colorado Health Memorial Hospital, Colorado Springs, Colorado.
• J Trauma Acute Care Surg. 2021 May 1; 90 (5): 769-775.

BackgroundPredicting rib fracture patients that will require higher-level care is a challenge during patient triage. Percentage of predicted forced vital capacity (FVC%) incorporates patient-specific factors to customize the measurements to each patient. A single institution transitioned from a clinical practice guideline (CPG) using absolute forced vital capacity (FVC) to one using FVC% to improve triage of rib fracture patients. This study compares the outcomes of patients before and after the CPG change.MethodsA review of rib fracture patients was performed over a 3-year retrospective period (RETRO) and 1-year prospective period (PRO). RETRO patients were triaged by absolute FVC. Percentage of predicted FVC was used to triage PRO patients. Demographics, mechanism, Injury Severity Score, chest Abbreviated Injury Scale score, number of rib fractures, tube thoracostomy, intubation, admission to intensive care unit (ICU), transfer to ICU, hospital length of stay (LOS), ICU LOS, and mortality data were compared. A multivariable model was constructed to perform adjusted analysis for LOS.ResultsThere were 588 patients eligible for the study, with 269 RETRO and 319 PRO patients. No significant differences in age, gender, or injury details were identified. Fewer tube thoracostomy were performed in PRO patients. Rates of intubation, admission to ICU, and mortality were similar. The PRO cohort had fewer ICU transfers and shorter LOS and ICU LOS. Multivariable logistic regression identified a 78% reduction in odds of ICU transfer among PRO patients. Adjusted analysis with multiple linear regression showed LOS was decreased 1.28 days by being a PRO patient in the study (B = -1.44; p < 0.001) with R2 = 0.198.ConclusionPercentage of predicted FVC better stratified rib fracture patients leading to a decrease in transfers to the ICU, ICU LOS, and hospital LOS. By incorporating patient-specific factors into the triage decision, the new CPG optimized triage and decreased resource utilization over the study period.Level Of EvidenceTherapeutic/Care Management. Trauma, Rib, Triage, level IV.Copyright © 2021 American Association for the Surgery of Trauma.

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