Abstract The lack of national guidelines for rib fracture management often leads to suboptimal management and underestimation of risks, resulting in significant morbidity, especially respiratory complications in elderly patients. This study evaluated current practices and developed local guidelines for rib fracture management using STUMBL score. First phase reviewed three months of data, calculating STUMBL scores for patients with CT proven rib fractures. Findings were presented at local governance meeting, prompting the creation of a rib fracture pathway in collaboration with Surgical, Anesthetic, and Emergency leads. The pathway recommended admitting patients with complicated fractures, STUMBL scores ≥11, or other clinical concerns under surgeons, while anesthetic colleagues proposed a flowchart for analgesia management. For frail patients with frailly score of 6, urgent plan for escalation of care was recommended. Clinical outcomes were re-audited 3 months later. Among 76 patients with confirmed rib fractures from blunt trauma (Mean age: 73 years), 8% had bilateral fractures, 28% had chronic lung conditions, and 30% had complicated rib fractures. Of those, 10.6% patients had STUMBL scores 11 and were admitted under surgical care and discharged the next day after receiving analgesia. While 17.2% with STUMBL scores ≥11 were discharged from A&E after initial pain management. Of the latter group, 45.8%patients were re-admitted to hospital with complications. Following the pathway’s introduction, patient outcomes improved significantly. Implementing a rib fracture pathway based on the STUMBL score enhanced patient outcomes. This underscores the importance of structured local protocols in addressing care gaps caused by the absence of national guidelines.
Jaskani et al. (Fri,) studied this question.
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