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Open Access

Emergency department management of patients with rib fracture based on a clinical practice guideline

Chase Hamilton, Lauren Barnett, Allison Trop, Brian Leininger, Adam Olson, Aaron Brooks, Daniel Clark, Thomas Schroeppel
DOI: 10.1136/tsaco-2017-000133 Published 22 December 2017
Chase Hamilton
1Rocky Vista University, Parker, Colorado, USA
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Lauren Barnett
2Department of Emergency Medicine, University of Colorado Health-South, Memorial Hospital, Colorado Springs, Colorado, USA
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Allison Trop
2Department of Emergency Medicine, University of Colorado Health-South, Memorial Hospital, Colorado Springs, Colorado, USA
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Brian Leininger
3Department of Trauma and Acute Care Surgery, University of Colorado Health-South, Memorial Hospital, Colorado Springs, Colorado, USA
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Adam Olson
1Rocky Vista University, Parker, Colorado, USA
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Aaron Brooks
1Rocky Vista University, Parker, Colorado, USA
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Daniel Clark
1Rocky Vista University, Parker, Colorado, USA
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Thomas Schroeppel
3Department of Trauma and Acute Care Surgery, University of Colorado Health-South, Memorial Hospital, Colorado Springs, Colorado, USA
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    Figure 1

    Clinical practice guideline for rib fracture algorithm—emergency department management. 

Tables

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  • Table 1

    Demographics and comparisons of successful discharge and return to the emergency department (ED)

    Total study (n=233)Return ED– (n=205)Return ED+ (n=28)P
    Male64%65%57%0.394
    Age53 (43–62)54 (44–63)49.5 (38–57)0.133
    FVC (mL)2500 (1900–3200)2550 (1950–3270)2300 (1735–2600)0.074
    ED LOS (minutes)232 (180–301)232 (182–299)225 (154–330)0.900
    Rib fractures2 (1–3)2 (1–2)2 (1–3.5)0.217
    Pulmonary contusion1.7%1.5%3.6%0.403
    MVC11.2%11.7%7.1%0.749
    MCC3.9%3.4%7.1%0.295
    Fall60.9%62.0%53.6%0.394
    Assault11.6%10.2%22.2%0.109
    • Categorical variables are presented as percentages. Continuous variables are presented as median (IQR).

    • FVC, forced vital capacity; LOS, length of stay; MCC, motorcycle collision; MVC, motor vehicle collision.

  • Table 2

    Regression analysis predicting return to the emergency department

    AORCIP
    Age0.9730.944 to 1.0020.065
    FVC0.9990.999 to 1.0000.027
    Assault1.6400.549 to 4.9890.375
    • AOR, adjusted OR; FVC, forced vital capacity.

  • Table 3

    Independent predictors of return to the emergency department

    AORCIP
    Age0.9680.942 to 0.9960.025
    FVC0.9990.999 to 1.0000.018
    • AOR, adjusted OR; FVC, forced vital capacity.

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Emergency department management of patients with rib fracture based on a clinical practice guideline
Chase Hamilton, Lauren Barnett, Allison Trop, Brian Leininger, Adam Olson, Aaron Brooks, Daniel Clark, Thomas Schroeppel
Trauma Surg Acute Care Open Dec 2017, 2 (1) e000133; DOI: 10.1136/tsaco-2017-000133

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Emergency department management of patients with rib fracture based on a clinical practice guideline
Chase Hamilton, Lauren Barnett, Allison Trop, Brian Leininger, Adam Olson, Aaron Brooks, Daniel Clark, Thomas Schroeppel
Trauma Surg Acute Care Open Dec 2017, 2 (1) e000133; DOI: 10.1136/tsaco-2017-000133
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Emergency department management of patients with rib fracture based on a clinical practice guideline
Chase Hamilton, Lauren Barnett, Allison Trop, Brian Leininger, Adam Olson, Aaron Brooks, Daniel Clark, Thomas Schroeppel
Trauma Surgery & Acute Care Open Dec 2017, 2 (1) e000133; DOI: 10.1136/tsaco-2017-000133
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