• 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, and Frederick A Moore.
• Department of Surgery, The Methodist Hospital, 6550 Fannin Street, Smith Tower 1661, Houston, TX 77030, USA. srtodd@tmh.tmc.edu <srtodd@tmh.tmc.edu>
• Am. J. Surg. 2006 Dec 1;192(6):806-11.

BackgroundWe 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.MethodsThis 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.ResultsWhen 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).ConclusionsImplementation of a rib fracture multidisciplinary clinical pathway decreased mechanical ventilator-dependent days, lengths of stay, infectious morbidity, and mortality.

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