411 Bridging the Gap in Rib Fracture Care: Developing a STUMBL Score-Based Multidisciplinary Pathway

Résumé fourni par la source

Abstract Aim Rib fractures, particularly in elderly, carry a high risk of complications and morbidity, often leading to severe respiratory issues if not managed effectively. The absence of national guidelines for rib fracture management has resulted in inconsistent management, treatment delays, and poor outcomes. This study aimed to evaluate current practices and develop a local Rib fracture management pathway utilizing the STUMBL score to enhance patient outcomes. Method A six-month review of hospital records with CT-proven Rib fractures was conducted calculating the STUMBL score. Findings were presented at local audit meetings, culminating in the creation of a multidisciplinary management pathway in collaboration with surgical, anesthetic, and ED trauma teams. Recommendation was to consider admission for complicated fractures, STUMBL scores ≥11, or other clinical concerns under surgical care, while anesthetics proposed a pain management flowchart, and outcomes were reassessed. Results Seventy-six patients with blunt trauma-induced rib fractures were included, with a mean age of 73 years. Of these, 8% had bilateral fractures, 28% had chronic lung conditions, and 30% had complicated fractures. Among patients with STUMBL scores <11, 10.6% were admitted and discharged the next day after receiving analgesia. In contrast, 17.2% of those with scores ≥11 was discharged from A&E but 45.8% were later re-admitted with complications. Following pathway implementation, patient outcomes improved markedly, with fewer complications and readmissions. Conclusions The introduction of a local rib fracture management pathway based on STUMBL score significantly improved outcomes, underscoring the value of evidence-based, localized protocols in the absence of national guidelines.

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